Healthcare Provider Details

I. General information

NPI: 1306107867
Provider Name (Legal Business Name): NOELLA MASALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 MALLARD DR STE 210
LAUREL MD
20708-3199
US

IV. Provider business mailing address

11201 HOMESTEAD DR APT A2
UPPER MARLBORO MD
20774-5761
US

V. Phone/Fax

Practice location:
  • Phone: 443-713-8643
  • Fax:
Mailing address:
  • Phone: 240-898-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR208446
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024193733
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1031963
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: