MEDICARE: DYNESTHIA AUGUSTINE

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1710843339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYNESTHIA AUGUSTINE

Provider Business Mailing Address
First Line	:	1109 QUEENS PURCHASE RD APT K
Second Line	:
City	:	ESSEX
State	:	MD
Zip	:	21221-5647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 LAKE WORTH RD STE 112
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3213
Country	:	US
Telephone Number	:	561-919-9084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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