Provider Demographics
NPI:1467158998
Name:WELLNESS EGO, LLC
Entity Type:Organization
Organization Name:WELLNESS EGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHUANNA
Authorized Official - Middle Name:TONI
Authorized Official - Last Name:MONCRIEFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MSCEM, NASM-CNC
Authorized Official - Phone:301-974-1425
Mailing Address - Street 1:9812 FALLS RD STE 114-324
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3976
Mailing Address - Country:US
Mailing Address - Phone:240-762-1279
Mailing Address - Fax:
Practice Address - Street 1:12820 RIVER RD STE HGH
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-1139
Practice Address - Country:US
Practice Address - Phone:240-762-1279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No174200000XOther Service ProvidersMeals
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2407621279OtherPHONE NUMBER
WELLNESSEGOOtherNAME