Provider Demographics
NPI:1083156855
Name:WELLNESS PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:WELLNESS PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:EMOUNGU
Authorized Official - Last Name:FLOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-356-7882
Mailing Address - Street 1:3930 PENDER DR STE 215
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0992
Mailing Address - Country:US
Mailing Address - Phone:703-356-7882
Mailing Address - Fax:703-356-4850
Practice Address - Street 1:3930 PENDER DR STE 215
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0992
Practice Address - Country:US
Practice Address - Phone:703-356-7882
Practice Address - Fax:703-356-4850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255280208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty