Healthcare Provider Details

I. General information

NPI: 1396612081
Provider Name (Legal Business Name): DB WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HILTON AVE STE 4
HEMPSTEAD NY
11550-8116
US

IV. Provider business mailing address

230 HILTON AVE STE 4
HEMPSTEAD NY
11550-8116
US

V. Phone/Fax

Practice location:
  • Phone: 516-401-0194
  • Fax: 516-232-9534
Mailing address:
  • Phone: 516-401-0194
  • Fax: 516-232-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DWAYNE BLAKE
Title or Position: CEO
Credential: NP
Phone: 516-402-0194