Organization
INSTITUTE OF ETERNAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SHANIKA MALCOLM RYT, RM, ND (CEO)
(267) 266-1320
Entity
Organization
Contact information
Practice address
2522 S BELLFORD ST, PHILADELPHIA, PA 19153-1411
(267) 266-1320
Mailing address
2522 S BELLFORD ST, PHILADELPHIA, PA 19153-1411
(267) 266-1320
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
374J00000X
Doula
Primary
—
—
374K00000X
Religious Nonmedical Practitioner
—
—
Other
Enumeration date
02/15/2012
Last updated
02/15/2012
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