MEDICARE: DIABETIC SUPPLY WELLNESS TEAM

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	332B00000X	Durable Medical Equipment & Medical Supplies	0600037	FL

General Provider Information

NPI Number	:	1790708923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC SUPPLY WELLNESS TEAM

Provider Business Mailing Address
First Line	:	75 NE 6TH AVE
Second Line	:	STE 219
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3471
Country	:	US
Telephone Number	:	561-266-9575
Fax Number	:	561-266-9577

Provider Business Practice Location Address
First Line	:	75 NE 6TH AVE
Second Line	:	STE 219
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-3471
Country	:	US
Telephone Number	:	561-266-9575
Fax Number	:	561-266-9577

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. CANDY DENICE BIEDERMAN
Credential	:
Telephone Number	:	561-266-9575

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/22/2020

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