Healthcare Provider Details

I. General information

NPI: 1720915911
Provider Name (Legal Business Name): DACIA IMAN UNDERWOOD CRNP-PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 EDISON HWY
BALTIMORE MD
21213-1667
US

IV. Provider business mailing address

2809 EDISON HWY
BALTIMORE MD
21213-1667
US

V. Phone/Fax

Practice location:
  • Phone: 240-888-4275
  • Fax:
Mailing address:
  • Phone: 240-888-4275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR234117
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: