Healthcare Provider Details

I. General information

NPI: 1326785551
Provider Name (Legal Business Name): HEALTHY KIDZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10410 PARK RD STE 100
CHARLOTTE NC
28210-6568
US

IV. Provider business mailing address

10410 PARK RD STE 100
CHARLOTTE NC
28210-6568
US

V. Phone/Fax

Practice location:
  • Phone: 704-540-6860
  • Fax: 704-659-4194
Mailing address:
  • Phone: 704-540-6860
  • Fax: 704-659-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: POORNIMA BADDI
Title or Position: MD
Credential: MD
Phone: 573-891-9127