MEDICARE: SCULPT WELLNESS AND WEIGHT LOSS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QI0500X	Infusion Therapy Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center
3	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1568319473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCULPT WELLNESS AND WEIGHT LOSS LLC

Provider Business Mailing Address
First Line	:	5115 BERNARD DR STE 106
Second Line	:
City	:	CAVE SPRING
State	:	VA
Zip	:	24018-4367
Country	:	US
Telephone Number	:	540-200-8336
Fax Number	:

Provider Business Practice Location Address
First Line	:	5115 BERNARD DR STE 106
Second Line	:
City	:	CAVE SPRING
State	:	VA
Zip	:	24018-4367
Country	:	US
Telephone Number	:	540-200-8336
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DIANA WILLIAMS
Credential	:
Telephone Number	:	606-369-0554

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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