Healthcare Provider Details

I. General information

NPI: 1235475674
Provider Name (Legal Business Name): GAYATRI PESTONJEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 THOMAS JOHNSON DR SUITE 215
FREDERICK MD
21702-4397
US

IV. Provider business mailing address

196 THOMAS JOHNSON DR SUITE 215
FREDERICK MD
21702-4397
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-9988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR203948
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: