Healthcare Provider Details

I. General information

NPI: 1144172065
Provider Name (Legal Business Name): MISS ANSERIDA BEENUNULA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 1ST ST SE
WASHINGTON DC
20003-1804
US

IV. Provider business mailing address

2251 SHERMAN AVE NW
WASHINGTON DC
20001-4003
US

V. Phone/Fax

Practice location:
  • Phone: 202-470-4185
  • Fax:
Mailing address:
  • Phone: 540-805-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-458886
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: