Healthcare Provider Details

I. General information

NPI: 1568319473
Provider Name (Legal Business Name): SCULPT WELLNESS AND WEIGHT LOSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 BERNARD DR STE 106
CAVE SPRING VA
24018-4367
US

IV. Provider business mailing address

5115 BERNARD DR STE 106
CAVE SPRING VA
24018-4367
US

V. Phone/Fax

Practice location:
  • Phone: 540-200-8336
  • Fax:
Mailing address:
  • Phone: 540-200-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANA WILLIAMS
Title or Position: MANAGING PARTNER
Credential:
Phone: 606-369-0554