MEDICARE: OPTIMAL FUNCTION AND WELLNESS, PLLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1164253183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL FUNCTION AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	1454 ROANOKE RD
Second Line	:
City	:	DALEVILLE
State	:	VA
Zip	:	24083-2935
Country	:	US
Telephone Number	:	540-312-3981
Fax Number	:

Provider Business Practice Location Address
First Line	:	1454 ROANOKE RD
Second Line	:
City	:	DALEVILLE
State	:	VA
Zip	:	24083-2935
Country	:	US
Telephone Number	:	540-312-3981
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHERRY MICHELLE BOONE
Credential	:	ACNP-C
Telephone Number	:	540-312-3981

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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