Healthcare Provider Details

I. General information

NPI: 1861366627
Provider Name (Legal Business Name): SATRA MIRMIRANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 SHADY GROVE RD STE 401
ROCKVILLE MD
20850-3218
US

IV. Provider business mailing address

11304 BROAD GREEN DR
POTOMAC MD
20854-2025
US

V. Phone/Fax

Practice location:
  • Phone: 240-912-4683
  • Fax: 240-912-4695
Mailing address:
  • Phone: 301-651-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR128982
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: