Healthcare Provider Details

I. General information

NPI: 1477481117
Provider Name (Legal Business Name): AVICENNA ACUPUNCTURE &HERBAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10220 RIVER RD STE 206
POTOMAC MD
20854-4911
US

IV. Provider business mailing address

10220 RIVER RD STE 206
POTOMAC MD
20854-4911
US

V. Phone/Fax

Practice location:
  • Phone: 240-422-0756
  • Fax:
Mailing address:
  • Phone: 240-422-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. FARAHNAZ BEHROOZIESFAHANI
Title or Position: OWNER
Credential: DAC
Phone: 240-422-0756