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General NPI Number Information
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NPI Number | 1609515022
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Entity Type | Organization
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Legal Business Name | MY JAVOY AT SERENITY WELLNESS CARE LLC
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 18625 HEDGEGROVE TER
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City | OLNEY
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State | MD
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Zip | 20832-1812
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Country | US
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Telephone | 240-780-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 18625 HEDGEGROVE TER
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City | OLNEY
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State | MD
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Zip | 20832-1812
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Country | US
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Telephone | 240-780-8003
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Fax |
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Authorized Official
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Title or Position | CEP
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Name | FYNDA FILLIE-FABOE
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Credential | CRNP
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Telephone | 240-780-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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