Healthcare Provider Details

I. General information

NPI: 1932045325
Provider Name (Legal Business Name): WELLNESSMODE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12210 FAIRFAX TOWNE CTR # 59
FAIRFAX VA
22033-2877
US

IV. Provider business mailing address

12210 FAIRFAX TOWNE CTR # 59
FAIRFAX VA
22033-2877
US

V. Phone/Fax

Practice location:
  • Phone: 201-649-2038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MALAIEKA WAQAR
Title or Position: MANAGER
Credential:
Phone: 201-649-2038