Healthcare Provider Details

I. General information

NPI: 1063321396
Provider Name (Legal Business Name): MAHALIA DEBRU
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12944 TRAVILAH RD
POTOMAC MD
20854-1079
US

IV. Provider business mailing address

41 MIDLINE CT
GAITHERSBURG MD
20878-1996
US

V. Phone/Fax

Practice location:
  • Phone: 240-477-7187
  • Fax:
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: