Shining Path Wellness Clinic LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SHINING PATH WELLNESS CLINIC LLC

Practice address

12345 Parklawn Dr Ste 200
Rockville, MD 20852-1725

Phone

(301) 355-3145

NPI assigned

Aug 12, 2025

Last updated

Dec 3, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Afusat Deng, DNP, PMHNP-BCNPI 1295571396

Title

Owner

Phone

(332) 330-3903

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Afusat K.O. Deng, DNP, PMHNP-BC, MSN

  • Psychiatric/Mental Health Nurse Practitioner
  • Rockville, MD
  • NPI 1295571396
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1754956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764720000000",
    "number": "1851277370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12345 PARKLAWN DR STE 200",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521725",
            "telephone_number": "301-355-3145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12345 PARKLAWN DR STE 200",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521725",
            "telephone_number": "301-355-3145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINING PATH WELLNESS CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-12",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A",
        "authorized_official_last_name": "DENG",
        "authorized_official_first_name": "AFUSAT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "332-330-3903",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kanchan Shimpi, M.D.
• Song Bok Shin
• Sun K Shin, L.AC
• Jeff Shinal, LCPC
• Mariah Ann Shingler
• Michal D Shinkle, DC
• Saira Shinwari
• Cierra Shipe
• Elizabeth Shipley
• Shelby Shipp

• Psychiatric/Mental Health Nurse Practitioner in Rockville, MD
• Providers in Rockville, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.