Provider Demographics
NPI:1467269027
Name:WAVES HEALTH CONNECT LLC
Entity type:Organization
Organization Name:WAVES HEALTH CONNECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIZPAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADOS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:703-475-9365
Mailing Address - Street 1:2700 NEABSCO COMMON PL STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6767
Mailing Address - Country:US
Mailing Address - Phone:703-475-9365
Mailing Address - Fax:703-670-0290
Practice Address - Street 1:2700 NEABSCO COMMON PL STE 101
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6767
Practice Address - Country:US
Practice Address - Phone:703-475-9365
Practice Address - Fax:703-670-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty