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General NPI Number Information
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NPI Number | 1396268405
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Entity Type | Organization
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Legal Business Name | HER WELLNESS HEALTH CENTER LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 65 OLD RIDGEFIELD RD
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City | WILTON
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State | CT
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Zip | 06897-3018
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Country | US
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Telephone | 203-665-0900
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Fax | 203-665-0899
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Provider Business Mailing Address
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Address Line | 19 GROUND PINE RD
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City | WILTON
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State | CT
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Zip | 06897-1917
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Country | US
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Telephone | 914-523-3469
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KIKELOMO OTUYELU-GARRITANO
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Credential | MD
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Telephone | 914-523-3469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 047101
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License Number State | CT
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