MEDICARE: MUDITA LIVING LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1144945528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUDITA LIVING LLC.

Provider Business Mailing Address
First Line	:	23699 HEATHER MEWS DR
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20148-1812
Country	:	US
Telephone Number	:	571-449-0853
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 E HOLLY AVE
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164-2612
Country	:	US
Telephone Number	:	571-449-0853
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. VANDANA PONNALA
Credential	:
Telephone Number	:	571-449-0853

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	10/07/2022

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Directions to “MUDITA LIVING LLC. ” Practice Location

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