MEDICARE: SHINEFORTH HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1104533371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINEFORTH HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	3611 BRANCH AVE STE 404
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1251
Country	:	US
Telephone Number	:	301-633-2515
Fax Number	:

Provider Business Practice Location Address
First Line	:	3611 BRANCH AVE STE 404
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1251
Country	:	US
Telephone Number	:	301-633-2515
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	UCHE H FABIKU
Credential	:	DNP, PMHNP, FNP
Telephone Number	:	301-633-2515

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	10/27/2022

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Directions to “SHINEFORTH HEALTH SERVICES LLC ” Practice Location

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