Healthcare Provider Details

I. General information

NPI: 1073165619
Provider Name (Legal Business Name): AASTHA AMDC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12210 PLUM ORCHARD DR STE 214
SILVER SPRING MD
20904-7913
US

IV. Provider business mailing address

12210 PLUM ORCHARD DR STE 214
SILVER SPRING MD
20904-7913
US

V. Phone/Fax

Practice location:
  • Phone: 240-813-3446
  • Fax: 240-474-0069
Mailing address:
  • Phone: 240-813-3446
  • Fax: 240-474-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SREE N SREENATH
Title or Position: CEO
Credential: PH.D., MNO
Phone: 440-318-9660