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General NPI Number Information
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NPI Number | 1376456053
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Entity Type | Organization
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Legal Business Name | EVERWELL LUXE
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 25 BROADWAY # 1
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City | KISSIMMEE
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State | FL
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Zip | 34741-5711
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Country | US
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Telephone | 863-206-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 39873 HIGHWAY 27
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City | DAVENPORT
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State | FL
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Zip | 33837-7802
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Country | US
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Telephone | 863-206-9696
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAVONA BUTLER
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Credential |
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Telephone | 863-206-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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