Healthcare Provider Details

I. General information

NPI: 1336052869
Provider Name (Legal Business Name): MIRACLE HEALTHCARE AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 PLENTY GATES LN # A
WALDORF MD
20601-5602
US

IV. Provider business mailing address

2408 PLENTY GATES LN # A
WALDORF MD
20601-5602
US

V. Phone/Fax

Practice location:
  • Phone: 130-161-3696
  • Fax:
Mailing address:
  • Phone: 130-161-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TOYIN MARY AJAYI
Title or Position: CEO
Credential: DNP,FNP-BC
Phone: 301-613-6963