Healthcare Provider Details

I. General information

NPI: 1841134053
Provider Name (Legal Business Name): BYKOTA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LYNDALE AVE
NOTTINGHAM MD
21236-4325
US

IV. Provider business mailing address

111 LYNDALE AVE
NOTTINGHAM MD
21236-4325
US

V. Phone/Fax

Practice location:
  • Phone: 443-360-5799
  • Fax: 443-460-2402
Mailing address:
  • Phone:
  • Fax: 443-460-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA CHANEY
Title or Position: CEO
Credential: LCSW-C
Phone: 443-360-5799