Healthcare Provider Details

I. General information

NPI: 1134023914
Provider Name (Legal Business Name): DYNAMIC PATHWAY HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MERION AVE
ROSEDALE MD
21237-1575
US

IV. Provider business mailing address

25 MERION AVE
ROSEDALE MD
21237-1575
US

V. Phone/Fax

Practice location:
  • Phone: 385-392-3077
  • Fax:
Mailing address:
  • Phone: 385-392-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. AJIBOLA OLAKUNLE HAZEEZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 385-392-3077