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General NPI Number Information
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NPI Number | 1619387636
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Entity Type | Organization
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Legal Business Name | WELLNESS WEALTH AND WISDOM FOR MIND,BODY,SOUL
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 121 VERNON AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10553-1811
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Country | US
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Telephone | 914-582-1928
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Fax |
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Provider Business Mailing Address
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Address Line | 121 VERNON AVENUE
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City | MOUNT VERNON
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State | NY
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Zip | 10553
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Country | US
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Telephone | 914-582-1928
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. YEDIDAH TAMAR YEHUDAH
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Credential | MS,RD,CDN
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Telephone | 914-582-1928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 004380-1
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License Number State | NY
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