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General NPI Number Information
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NPI Number | 1750205902
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Entity Type | Organization
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Legal Business Name | NIEAD
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Dates
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Enumeration Date | 08/08/2026
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Last Update Date | 08/08/2026
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Provider Practice Location Address
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Address Line | 5124B BALTIMORE AVE
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City | HYATTSVILLE
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State | MD
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Zip | 20781-2041
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Country | US
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Telephone | 240-988-9858
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Fax | 202-731-7762
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Provider Business Mailing Address
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Address Line | 9708 RISEN STAR DR
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-3855
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Country | US
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Telephone | 202-731-7762
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Fax | 202-731-7762
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Authorized Official
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Title or Position | CEO
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Name | MR. DORIAN SIBEDWO
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Credential |
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Telephone | 202-731-7762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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