Healthcare Provider Details

I. General information

NPI: 1063349777
Provider Name (Legal Business Name): NASTEHO MOALIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 E NORTH AVE
BALTIMORE MD
21213-1408
US

IV. Provider business mailing address

2020 HARLEQUIN TER
SILVER SPRING MD
20904-5355
US

V. Phone/Fax

Practice location:
  • Phone: 240-581-2918
  • Fax:
Mailing address:
  • Phone: 301-577-5473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: