MEDICARE: MOMMY'S OWN MILK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163WL0100X	Lactation Consultant (Registered Nurse)
2	174N00000X	Lactation Consultant (Non-RN)
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1104559103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMMY'S OWN MILK LLC

Provider Business Mailing Address
First Line	:	7401 WILES RD STE 322
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2036
Country	:	US
Telephone Number	:	954-507-7686
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 WILES RD STE 322
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2036
Country	:	US
Telephone Number	:	954-507-7686
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	NEENA PATEL
Credential	:
Telephone Number	:	954-531-9825

Provider Enumeration Date	:	07/06/2022
Last Update Date	:	01/07/2026

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