Healthcare Provider Details

I. General information

NPI: 1740881556
Provider Name (Legal Business Name): AYLA MICHELLE NEAL CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 SANGAMORE RD STE N270
BETHESDA MD
20816-2528
US

IV. Provider business mailing address

723 VELVET RUN CT
WESTMINSTER MD
21157-3823
US

V. Phone/Fax

Practice location:
  • Phone: 240-507-5110
  • Fax:
Mailing address:
  • Phone: 443-848-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX5125
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: