Healthcare Provider Details

I. General information

NPI: 1306753827
Provider Name (Legal Business Name): AXON PSYCHIATRY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 FENTON ST STE 209
SILVER SPRING MD
20910-6701
US

IV. Provider business mailing address

915 SILVER SPRING AVE APT 612
SILVER SPRING MD
20910-5083
US

V. Phone/Fax

Practice location:
  • Phone: 240-266-0675
  • Fax: 301-235-1598
Mailing address:
  • Phone: 240-266-0675
  • Fax: 301-235-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SENAY G TEDLA
Title or Position: CEO
Credential: PMHNP, DNP, MBA
Phone: 240-266-0675