Healthcare Provider Details

I. General information

NPI: 1801701099
Provider Name (Legal Business Name): MRS. AVITAL SHAINDEL GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 STANFORD BLVD STE 390
COLUMBIA MD
21045-4754
US

IV. Provider business mailing address

1121 UNIVERSITY BLVD W APT 109
SILVER SPRING MD
20902-3317
US

V. Phone/Fax

Practice location:
  • Phone: 410-200-9200
  • Fax:
Mailing address:
  • Phone: 347-543-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: