Healthcare Provider Details

I. General information

NPI: 1497619225
Provider Name (Legal Business Name): KAYANA MESIDOR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1589 SULPHUR SPRING RD STE 109
BALTIMORE MD
21227-2542
US

IV. Provider business mailing address

5410 MCGRATH BLVD APT 418
NORTH BETHESDA MD
20852-8744
US

V. Phone/Fax

Practice location:
  • Phone: 410-372-2189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR274984
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: