=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770464349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERITAGE WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2025
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 ALASKAN WAY S
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-3387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-442-5021
-----------------------------------------------------
Fax | 786-921-0041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13100 W DIXIE HWY
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33161-4131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-442-5021
-----------------------------------------------------
Fax | 786-921-0041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SONIA CHOUTE-EDOUARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-333-7017
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------