Provider Demographics
NPI:1962162917
Name:HERITAGE WELLNESS, LLC
Entity type:Organization
Organization Name:HERITAGE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:CHOUTE
Authorized Official - Last Name:EDOUARD
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:786-333-7017
Mailing Address - Street 1:12550 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 800 PMB 90
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181
Mailing Address - Country:US
Mailing Address - Phone:786-228-6612
Mailing Address - Fax:
Practice Address - Street 1:12550 BISCAYNE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181
Practice Address - Country:US
Practice Address - Phone:786-228-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty