MEDICARE: WHITE KOI WELLNESS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1760316186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE KOI WELLNESS

Provider Business Mailing Address
First Line	:	1551 SANDSPUR RD
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-6138
Country	:	US
Telephone Number	:	941-284-8497
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 SANDSPUR RD
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-6138
Country	:	US
Telephone Number	:	941-284-8497
Fax Number	:

Authorized Official
Title or Position	:	DIETITIAN
Name	:	MIKAELA COEL
Credential	:	MPH, RD, LDN
Telephone Number	:	941-284-8497

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “WHITE KOI WELLNESS ” Practice Location

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