Healthcare Provider Details

I. General information

NPI: 1093404782
Provider Name (Legal Business Name): MRS. ENIDSIA SHEILA DARBY-GILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 07/15/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 E BONIWOOD TURN
CLINTON MD
20735-4153
US

IV. Provider business mailing address

5745 E BONIWOOD TURN
CLINTON MD
20735-4153
US

V. Phone/Fax

Practice location:
  • Phone: 120-253-4898
  • Fax:
Mailing address:
  • Phone: 120-253-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number000000000
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: