Healthcare Provider Details

I. General information

NPI: 1518782291
Provider Name (Legal Business Name): DEEPLY ROOTED BIRTH & WELLNESS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 KAISER DR
FREDERICKSBURG VA
22407-1334
US

IV. Provider business mailing address

2105 KAISER DR
FREDERICKSBURG VA
22407-1334
US

V. Phone/Fax

Practice location:
  • Phone: 540-623-6584
  • Fax: 651-855-5201
Mailing address:
  • Phone: 540-623-6584
  • Fax: 651-855-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. SIEDAH SARAI-BAHT ISRAEL
Title or Position: CERTIFIED PROFESSIONAL DOULA
Credential: CPD
Phone: 540-623-6584