Healthcare Provider Details

I. General information

NPI: 1609611342
Provider Name (Legal Business Name): DORENE KYANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MEDICAL CENTER DR STE 262
LARGO MD
20774-3709
US

IV. Provider business mailing address

9500 MEDICAL CENTER DR STE 262
UPPER MARLBORO MD
20774-3709
US

V. Phone/Fax

Practice location:
  • Phone: 240-232-5607
  • Fax:
Mailing address:
  • Phone: 781-521-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31369
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: