Healthcare Provider Details

I. General information

NPI: 1750205902
Provider Name (Legal Business Name): NIEAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5124B BALTIMORE AVE
HYATTSVILLE MD
20781-2041
US

IV. Provider business mailing address

9708 RISEN STAR DR
UPPER MARLBORO MD
20772-3855
US

V. Phone/Fax

Practice location:
  • Phone: 240-988-9858
  • Fax: 202-731-7762
Mailing address:
  • Phone: 202-731-7762
  • Fax: 202-731-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DORIAN SIBEDWO
Title or Position: CEO
Credential:
Phone: 202-731-7762