Healthcare Provider Details

I. General information

NPI: 1245643733
Provider Name (Legal Business Name): JOCELYN SHEILA GAJUDO FERNANDEZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10759 EVENING WIND CT
COLUMBIA MD
21044-2413
US

IV. Provider business mailing address

10759 EVENING WIND CT
COLUMBIA MD
21044-2413
US

V. Phone/Fax

Practice location:
  • Phone: 424-644-5061
  • Fax:
Mailing address:
  • Phone: 424-644-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24833
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: