Healthcare Provider Details

I. General information

NPI: 1720723653
Provider Name (Legal Business Name): FARAHNAZ BEHROOZIESFAHANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N FREDERICK AVE STE 216
GAITHERSBURG MD
20877-2545
US

IV. Provider business mailing address

11534 SULLNICK WAY
GAITHERSBURG MD
20878-1000
US

V. Phone/Fax

Practice location:
  • Phone: 240-422-0756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02914
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: