Healthcare Provider Details

I. General information

NPI: 1598466963
Provider Name (Legal Business Name): VICKIE PODREZ CD(DONA), IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICKIE BENTHAM

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 FORREST RD
WINTER PARK FL
32789-6029
US

IV. Provider business mailing address

2300 FORREST RD
WINTER PARK FL
32789-6029
US

V. Phone/Fax

Practice location:
  • Phone: 407-416-0815
  • Fax:
Mailing address:
  • Phone: 407-416-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: