MEDICARE: KUB WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1275499535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUB WELLNESS LLC

Provider Business Mailing Address
First Line	:	621 GLEN LAKE DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-3558
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16701 MELFORD BLVD STE 400
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20715-4411
Country	:	US
Telephone Number	:	301-741-5828
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	BOLANLE SABA
Credential	:	APRN
Telephone Number	:	301-741-5828

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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Directions to “KUB WELLNESS LLC ” Practice Location

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