Healthcare Provider Details

I. General information

NPI: 1083411219
Provider Name (Legal Business Name): DEEPU PUDASAINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 301-400-1343
  • Fax: 301-295-4430
Mailing address:
  • Phone: 301-400-1343
  • Fax: 301-295-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR203101
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR203101
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: