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General NPI Number Information
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NPI Number | 1831900141
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Entity Type | Organization
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Legal Business Name | NIRVANA HOLISTIC SPA LLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 6201 GREENBELT RD STE U7
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City | BERWYN HEIGHTS
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State | MD
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Zip | 20740-2361
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Country | US
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Telephone | 301-798-7687
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Fax | 800-297-9152
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Provider Business Mailing Address
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Address Line | 6201 GREENBELT RD STE U7
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City | BERWYN HEIGHTS
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State | MD
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Zip | 20740-2361
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Country | US
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Telephone | 301-798-7687
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Fax | 800-297-9152
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAUNDEL KNIGHTS
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Credential | ND
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Telephone | 301-798-7687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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