Healthcare Provider Details

I. General information

NPI: 1447600465
Provider Name (Legal Business Name): SAYALI YEWALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37767 MARKET DR UNIT 200
CHARLOTTE HALL MD
20622-3199
US

IV. Provider business mailing address

37767 MARKET DR UNIT 200
CHARLOTTE HALL MD
20622-3199
US

V. Phone/Fax

Practice location:
  • Phone: 301-884-7330
  • Fax:
Mailing address:
  • Phone: 301-884-7330
  • Fax: 301-884-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD86889
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: