Healthcare Provider Details

I. General information

NPI: 1134084577
Provider Name (Legal Business Name): ELITE BODY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 W BIRDIE LN
MAGNOLIA DE
19962-3103
US

IV. Provider business mailing address

1182 W BIRDIE LN
MAGNOLIA DE
19962-3103
US

V. Phone/Fax

Practice location:
  • Phone: 302-480-3390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JONNISE FIELDS
Title or Position: OWNER
Credential: PMHNP
Phone: 302-480-3390