Provider Demographics
NPI:1104533371
Name:SHINEFORTH HEALTH SERVICES LLC
Entity type:Organization
Organization Name:SHINEFORTH HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:H
Authorized Official - Last Name:FABIKU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP, FNP
Authorized Official - Phone:301-633-2515
Mailing Address - Street 1:3611 BRANCH AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1251
Mailing Address - Country:US
Mailing Address - Phone:301-633-2515
Mailing Address - Fax:
Practice Address - Street 1:3611 BRANCH AVE STE 404
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1251
Practice Address - Country:US
Practice Address - Phone:301-633-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty