Healthcare Provider Details

I. General information

NPI: 1962103747
Provider Name (Legal Business Name): OPTIMAL SLEEP AND WEIGHT LOSS CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 HARBOR CENTER DR STE 212
WOODBRIDGE VA
22192-2847
US

IV. Provider business mailing address

13 CARROLL DR
STAFFORD VA
22554-5340
US

V. Phone/Fax

Practice location:
  • Phone: 703-955-5355
  • Fax: 703-955-5348
Mailing address:
  • Phone: 703-955-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PASCAL NGONGMON
Title or Position: MANAGER
Credential: MD
Phone: 703-955-5355