Healthcare Provider Details

I. General information

NPI: 1992297634
Provider Name (Legal Business Name): MS. AWILDA THEODORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 09/20/2026
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BELVEDERE RD STE 300E
WEST PALM BEACH FL
33406-1554
US

IV. Provider business mailing address

1601 BELVEDERE RD STE 300E
WEST PALM BEACH FL
33406-1554
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-1601
  • Fax: 561-214-6139
Mailing address:
  • Phone: 561-507-1601
  • Fax: 561-214-6139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number30212801
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: