Provider Demographics
NPI:1518708437
Name:CAVERY WELLNESS OF STAFFORD, LLC
Entity type:Organization
Organization Name:CAVERY WELLNESS OF STAFFORD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARSHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:540-930-6334
Mailing Address - Street 1:392 GARRISONVILLE RAOD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-4640
Mailing Address - Country:US
Mailing Address - Phone:571-408-9139
Mailing Address - Fax:
Practice Address - Street 1:392 GARRISONVILLE RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1500
Practice Address - Country:US
Practice Address - Phone:571-408-9139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty