Healthcare Provider Details

I. General information

NPI: 1053201640
Provider Name (Legal Business Name): FAWPEARLS HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 PROFESSIONAL PL
HYATTSVILLE MD
20785-2237
US

IV. Provider business mailing address

4312 ARABELLA CT
UPPER MARLBORO MD
20772-9343
US

V. Phone/Fax

Practice location:
  • Phone: 301-532-5849
  • Fax:
Mailing address:
  • Phone: 240-593-2260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ABIMBOLA SHADARE
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 240-593-2260