Provider Demographics
NPI:1831900141
Name:NIRVANA HOLISTIC SPA
Entity type:Organization
Organization Name:NIRVANA HOLISTIC SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHTS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:301-798-7687
Mailing Address - Street 1:6201 GREENBELT RD STE U7
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2361
Mailing Address - Country:US
Mailing Address - Phone:301-798-7687
Mailing Address - Fax:800-297-9152
Practice Address - Street 1:6201 GREENBELT RD STE U7
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2361
Practice Address - Country:US
Practice Address - Phone:301-798-7687
Practice Address - Fax:800-297-9152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIRVANA HOLISTIC SPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty