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General NPI Number Information
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NPI Number | 1992297634
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Entity Type | Individual
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Provider Name | MS. AWILDA THEODORE
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Gender | Female
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 1601 BELVEDERE RD STE 300E
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-1554
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Country | US
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Telephone | 561-507-1601
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Fax | 561-214-6139
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Provider Business Mailing Address
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Address Line | 1601 BELVEDERE RD STE 300E
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-1554
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Country | US
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Telephone | 561-507-1601
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Fax | 561-214-6139
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 30212801
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License Number State | FL
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