Healthcare Provider Details

I. General information

NPI: 1528319738
Provider Name (Legal Business Name): ASTRIDA AWA TENENG MDA, RD, CDCES, LD,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASTRIDA AWA FENGWI

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 03/09/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16567 SIOUX LN
GAITHERSBURG MD
20878-2048
US

IV. Provider business mailing address

16567 SIOUX LN
GAITHERSBURG MD
20878-2048
US

V. Phone/Fax

Practice location:
  • Phone: 240-780-8135
  • Fax:
Mailing address:
  • Phone: 502-303-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD-0837
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-0837
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: