Healthcare Provider Details

I. General information

NPI: 1578252144
Provider Name (Legal Business Name): SDORA WELLBEING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 REISTERSTOWN RD STE 109
PIKESVILLE MD
21208-2978
US

IV. Provider business mailing address

1700 REISTERSTOWN RD STE 109
PIKESVILLE MD
21208-2978
US

V. Phone/Fax

Practice location:
  • Phone: 877-772-5150
  • Fax: 667-400-5108
Mailing address:
  • Phone: 877-772-5150
  • Fax: 667-400-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DAMILOLA LOVETH AJONGBOLO
Title or Position: CEO
Credential: PHARMD
Phone: 443-858-6418