Healthcare Provider Details

I. General information

NPI: 1356623078
Provider Name (Legal Business Name): NANCY WUNDERLICH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 SHADY GROVE CT
GAITHERSBURG MD
20877-1308
US

IV. Provider business mailing address

8929 SHADY GROVE CT
GAITHERSBURG MD
20877-1308
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-8500
  • Fax: 301-869-1263
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number02941
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: