Healthcare Provider Details

I. General information

NPI: 1821859117
Provider Name (Legal Business Name): VIDYAWATI DEVI ITWARU-WOMACK NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

5951 FISH CT
ORLANDO FL
32807-2956
US

V. Phone/Fax

Practice location:
  • Phone: 407-579-1124
  • Fax:
Mailing address:
  • Phone: 407-928-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3254656
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: