Healthcare Provider Details

I. General information

NPI: 1508784265
Provider Name (Legal Business Name): NAOD FELLEKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14900 SWEITZER LN STE 106
LAUREL MD
20707-2915
US

IV. Provider business mailing address

14900 SWEITZER LN STE 106
LAUREL MD
20707-2915
US

V. Phone/Fax

Practice location:
  • Phone: 301-615-1007
  • Fax: 410-844-4026
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: