Healthcare Provider Details

I. General information

NPI: 1578790564
Provider Name (Legal Business Name): WINTANA KIROS RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15121 CENTERGATE DR
SILVER SPRING MD
20905-5714
US

IV. Provider business mailing address

2227 BEL PRE RD STE 104
SILVER SPRING MD
20906-2204
US

V. Phone/Fax

Practice location:
  • Phone: 410-952-2613
  • Fax:
Mailing address:
  • Phone: 410-952-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number999417
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: