Healthcare Provider Details

I. General information

NPI: 1740621754
Provider Name (Legal Business Name): BETHESDA BREASTFEEDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4927 AUBURN AVENUE SUITE 100
BETHESDA MD
20814
US

IV. Provider business mailing address

4927 AUBURN AVENUE SUITE 100
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 301-943-9293
  • Fax: 240-235-8327
Mailing address:
  • Phone: 301-801-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SARINYA POCHAKILO
Title or Position: DIRECTOR OF BUSINESS ADMINISTRATION
Credential:
Phone: 301-873-5049