Healthcare Provider Details

I. General information

NPI: 1447117023
Provider Name (Legal Business Name): SAVANNAH WHEAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E NASA BLVD STE 201
MELBOURNE FL
32901-1961
US

IV. Provider business mailing address

65 E NASA BLVD
MELBOURNE FL
32901-1912
US

V. Phone/Fax

Practice location:
  • Phone: 321-475-4265
  • Fax:
Mailing address:
  • Phone: 321-475-4265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: