Provider Demographics
NPI:1932779998
Name:DVYNE HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:DVYNE HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWATOSIN TOSIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-432-0286
Mailing Address - Street 1:16112 MCCONNELL DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3283
Mailing Address - Country:US
Mailing Address - Phone:240-432-0286
Mailing Address - Fax:
Practice Address - Street 1:10104 SENATE DR STE 222
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4393
Practice Address - Country:US
Practice Address - Phone:240-432-0286
Practice Address - Fax:240-523-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health