Healthcare Provider Details

I. General information

NPI: 1821746520
Provider Name (Legal Business Name): FELICIA GUNAWAN MASTERS OF SCIENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 03/13/2022
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15726 TROLLEY LN
SILVER SPRING MD
20906-1278
US

IV. Provider business mailing address

15726 TROLLEY LN
SILVER SPRING MD
20906-1278
US

V. Phone/Fax

Practice location:
  • Phone: 240-614-6891
  • Fax:
Mailing address:
  • Phone: 240-614-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: