Healthcare Provider Details

I. General information

NPI: 1518355981
Provider Name (Legal Business Name): SIA SAFFA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 GREENWAY CENTER DR UNIT 003
GREENBELT MD
20770
US

IV. Provider business mailing address

14921 DENNINGTON DR
BOWIE MD
20721-3273
US

V. Phone/Fax

Practice location:
  • Phone: 202-830-5465
  • Fax:
Mailing address:
  • Phone: 240-479-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR187072
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: