Healthcare Provider Details

I. General information

NPI: 1922750876
Provider Name (Legal Business Name): MS. JANET WADDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MADISON AVE STE 37
NEW YORK NY
10016-5412
US

IV. Provider business mailing address

526 47TH RD APT 2D
LONG ISLAND CITY NY
11101-5558
US

V. Phone/Fax

Practice location:
  • Phone: 917-359-8279
  • Fax:
Mailing address:
  • Phone: 917-359-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number22WA1100008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: