Healthcare Provider Details

I. General information

NPI: 1235752460
Provider Name (Legal Business Name): WHEAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 NE 203RD ST STE 109
MIAMI FL
33180-1945
US

IV. Provider business mailing address

2627 NE 203RD ST STE 109
MIAMI FL
33180-1945
US

V. Phone/Fax

Practice location:
  • Phone: 305-528-2836
  • Fax: 305-682-8994
Mailing address:
  • Phone: 305-682-8700
  • Fax: 305-682-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: REGINA F COOPER
Title or Position: DIRECTOR
Credential:
Phone: 954-661-7227