Healthcare Provider Details

I. General information

NPI: 1194524843
Provider Name (Legal Business Name): SBMD HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WYNDHURST AVE STE 160
BALTIMORE MD
21210-2495
US

IV. Provider business mailing address

600 WYNDHURST AVE STE 160
BALTIMORE MD
21210-2495
US

V. Phone/Fax

Practice location:
  • Phone: 410-621-9337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. SHA'LLAH SABRIYYAH BREWTON
Title or Position: PRINCIPAL
Credential: MD
Phone: 410-621-9337