MEDICARE: EAGLES NEST WELLNESS GROUP

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	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1427906262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLES NEST WELLNESS GROUP

Provider Business Mailing Address
First Line	:	3010 CRAIN HWY STE 302
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2838
Country	:	US
Telephone Number	:	804-433-6905
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 CRAIN HWY STE 302
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2838
Country	:	US
Telephone Number	:	804-433-6905
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. FERNANDO LEE ANDREWS JR.
Credential	:
Telephone Number	:	804-433-6905

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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