Healthcare Provider Details

I. General information

NPI: 1548171572
Provider Name (Legal Business Name): NOVA BIRTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43893 CHURCHILL GLEN DR
CHANTILLY VA
20152-5771
US

IV. Provider business mailing address

43893 CHURCHILL GLEN DR
CHANTILLY VA
20152-5771
US

V. Phone/Fax

Practice location:
  • Phone: 540-841-9293
  • Fax: --
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNON MATHEWS
Title or Position: OWNER
Credential: CD(DONA)
Phone: 540-841-9293