Healthcare Provider Details

I. General information

NPI: 1891601357
Provider Name (Legal Business Name): TAJASAN HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 S QUEEN ST
DOVER DE
19904-3572
US

IV. Provider business mailing address

487 S QUEEN ST
DOVER DE
19904-3572
US

V. Phone/Fax

Practice location:
  • Phone: 302-484-1377
  • Fax: 302-484-1377
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SITOLOMA
Title or Position: MANAGING MEMBER
Credential: APRN, FNP-BC
Phone: 302-484-1377