Healthcare Provider Details

I. General information

NPI: 1689299083
Provider Name (Legal Business Name): DASYLIA WILLOUGHBY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 MAPLE LAWN BLVD STE 350
FULTON MD
20759-2683
US

IV. Provider business mailing address

8115 MAPLE LAWN BLVD STE 350
FULTON MD
20759-2683
US

V. Phone/Fax

Practice location:
  • Phone: 301-923-1484
  • Fax: 301-923-1484
Mailing address:
  • Phone: 301-923-1484
  • Fax: 301-923-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102209903
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO210012768
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH0101506
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS023078
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: