MEDICARE: IMPACT HEALTH AND WELLNESS LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1720932965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPACT HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	6301 IVY LN STE 700
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-6330
Country	:	US
Telephone Number	:	443-599-9288
Fax Number	:	443-499-9433

Provider Business Practice Location Address
First Line	:	6301 IVY LN STE 700
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-6330
Country	:	US
Telephone Number	:	443-599-9288
Fax Number	:	443-499-9433

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MS. STEPHANIE C ANYAOHA
Credential	:	PMHNP-BC
Telephone Number	:	443-599-9288

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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