Provider Demographics
NPI:1245014778
Name:MANSARAY-SMITH, BAINDU LEEMU (PMHNP)
Entity type:Individual
Prefix:
First Name:BAINDU
Middle Name:LEEMU
Last Name:MANSARAY-SMITH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11602 BRIGIT CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4486
Mailing Address - Country:US
Mailing Address - Phone:240-441-7732
Mailing Address - Fax:
Practice Address - Street 1:19310 CLUB HOUSE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3029
Practice Address - Country:US
Practice Address - Phone:301-921-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194518363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health