Healthcare Provider Details

I. General information

NPI: 1750212494
Provider Name (Legal Business Name): CAROLYN KUSENDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N WOLFE ST APT 490
BALTIMORE MD
21231-1747
US

IV. Provider business mailing address

101 N WOLFE ST APT 490
BALTIMORE MD
21231-1747
US

V. Phone/Fax

Practice location:
  • Phone: 202-419-9081
  • Fax: 202-419-9081
Mailing address:
  • Phone: 202-419-9081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDX6312
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: