Provider Demographics
NPI:1770069064
Name:AFFYA HEALTH & WELLNES, LLC
Entity type:Organization
Organization Name:AFFYA HEALTH & WELLNES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHIRA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:443-469-0993
Mailing Address - Street 1:3477 HILLSMERE RD
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5610
Mailing Address - Country:US
Mailing Address - Phone:443-469-0993
Mailing Address - Fax:
Practice Address - Street 1:20 CROSSROADS DR STE 104
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5480
Practice Address - Country:US
Practice Address - Phone:443-469-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01643133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty