Healthcare Provider Details

I. General information

NPI: 1417660606
Provider Name (Legal Business Name): SAILWINDS MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GOODWILL AVE
CAMBRIDGE MD
21613-2972
US

IV. Provider business mailing address

1000 GOODWILL AVE
CAMBRIDGE MD
21613-2972
US

V. Phone/Fax

Practice location:
  • Phone: 443-972-4204
  • Fax: 443-733-4435
Mailing address:
  • Phone: 443-972-4204
  • Fax: 443-733-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDON MCMULLEN
Title or Position: PRESIDENT
Credential: PA-C
Phone: 443-972-4204