Healthcare Provider Details

I. General information

NPI: 1083156855
Provider Name (Legal Business Name): WELLNESS PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 PENDER DR STE 215
FAIRFAX VA
22030-0992
US

IV. Provider business mailing address

3930 PENDER DR STE 215
FAIRFAX VA
22030-0992
US

V. Phone/Fax

Practice location:
  • Phone: 703-356-7882
  • Fax: 703-356-4850
Mailing address:
  • Phone: 703-356-7882
  • Fax: 703-356-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101255280
License Number StateVA

VIII. Authorized Official

Name: DR. TINA EMOUNGU FLOY
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 703-356-7882