Healthcare Provider Details

I. General information

NPI: 1023293354
Provider Name (Legal Business Name): SANJAY PRASAD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2008
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 SHADY GROVE RD STE 350
ROCKVILLE MD
20850-6376
US

IV. Provider business mailing address

15005 SHADY GROVE RD STE 35O
ROCKVILLE MD
20850-6340
US

V. Phone/Fax

Practice location:
  • Phone: 301-493-9409
  • Fax: 301-493-9429
Mailing address:
  • Phone: 301-493-9409
  • Fax: 301-493-9429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SANJAY PRASAD
Title or Position: PRESIDENT
Credential: MD
Phone: 301-807-3840