Healthcare Provider Details

I. General information

NPI: 1053139980
Provider Name (Legal Business Name): AMAZING HEALTHCARE CLINIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6495 NEW HAMPSHIRE AVE # A203
HYATTSVILLE MD
20783-3245
US

IV. Provider business mailing address

10903 N RIDING RD
UPPER MARLBORO MD
20772-8398
US

V. Phone/Fax

Practice location:
  • Phone: 301-798-5583
  • Fax: 301-798-6260
Mailing address:
  • Phone: 301-798-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOSEDE M ADELEYE
Title or Position: PROVIDER
Credential: PMHNP-BC
Phone: 301-798-5583