Provider Demographics
NPI:1467024554
Name:OPTIMALLY VIBRANT HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:OPTIMALLY VIBRANT HEALTH & WELLNESS, LLC
Other - Org Name:OPTIMALLY VIBRANT WITH MALAIKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALAIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOWALE-MCQUILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, LDN
Authorized Official - Phone:302-314-2950
Mailing Address - Street 1:364 E MAIN ST STE 1508
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1482
Mailing Address - Country:US
Mailing Address - Phone:302-314-2950
Mailing Address - Fax:302-378-8087
Practice Address - Street 1:834 SWEET BIRCH DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-7873
Practice Address - Country:US
Practice Address - Phone:302-376-6901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty