Healthcare Provider Details

I. General information

NPI: 1447105135
Provider Name (Legal Business Name): REBECCA STAPLE CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORMANDY DR
SILVER SPRING MD
20901-3116
US

IV. Provider business mailing address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

V. Phone/Fax

Practice location:
  • Phone: 571-357-4677
  • Fax:
Mailing address:
  • Phone: 571-357-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX7552
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: