Provider Demographics
NPI:1861104283
Name:DYN TELEHEALTH CLINIC
Entity type:Organization
Organization Name:DYN TELEHEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MALEFIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADESSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6
Mailing Address - Street 1:1332 CHAPEL CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1978
Mailing Address - Country:US
Mailing Address - Phone:6
Mailing Address - Fax:
Practice Address - Street 1:1332 CHAPEL CENTRE DR
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1978
Practice Address - Country:US
Practice Address - Phone:6
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care