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General NPI Number Information
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NPI Number | 1851277370
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Entity Type | Organization
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Legal Business Name | SHINING PATH WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 12345 PARKLAWN DR STE 200
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City | ROCKVILLE
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State | MD
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Zip | 20852-1725
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Country | US
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Telephone | 301-355-3145
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Fax |
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Provider Business Mailing Address
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Address Line | 12345 PARKLAWN DR STE 200
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City | ROCKVILLE
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State | MD
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Zip | 20852-1725
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Country | US
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Telephone | 301-355-3145
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AFUSAT DENG
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Credential | DNP, PMHNP-BC
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Telephone | 332-330-3903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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