Healthcare Provider Details

I. General information

NPI: 1548179922
Provider Name (Legal Business Name): VALERY ETOBAYEV
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 ARLINGTON RD STE G2
BETHESDA MD
20814-5211
US

IV. Provider business mailing address

4938 HAMPDEN LN STE 311
BETHESDA MD
20814-2914
US

V. Phone/Fax

Practice location:
  • Phone: 301-701-6046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberR03548
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: