Healthcare Provider Details

I. General information

NPI: 1205636644
Provider Name (Legal Business Name): CHAUNTOYIA JANAE LAVETTE EDWARDS NBHWC, CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 RIVER GROVE WAY
WEST PALM BEACH FL
33407-2137
US

IV. Provider business mailing address

195 RIVER GROVE WAY APT 603
WEST PALM BEACH FL
33407-2179
US

V. Phone/Fax

Practice location:
  • Phone: 919-696-0448
  • Fax:
Mailing address:
  • Phone: 919-696-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3790214
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: