Healthcare Provider Details

I. General information

NPI: 1144548660
Provider Name (Legal Business Name): SUREKHA GORANTLA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 RIVER ROAD DYRS NEW BEGINNINGS
LAUREL MD
20708
US

IV. Provider business mailing address

9450 MARLBORO PILE STE 19
UPPER MARLBORO MD
20772
US

V. Phone/Fax

Practice location:
  • Phone: 202-299-3200
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1003059
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR167915
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: