Healthcare Provider Details

I. General information

NPI: 1063325538
Provider Name (Legal Business Name): BALANCED HEALTH THERAPY LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

IV. Provider business mailing address

8924B WALKERTON DR
LANHAM MD
20706-1963
US

V. Phone/Fax

Practice location:
  • Phone: 227-770-0744
  • Fax:
Mailing address:
  • Phone: 227-770-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ISABELLA KENYEN NGEDZEYEEM
Title or Position: CRNP-PMH
Credential:
Phone: 227-770-0744