Healthcare Provider Details

I. General information

NPI: 1619833035
Provider Name (Legal Business Name): MADEVA GUNNALA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 N LEISURE WORLD BLVD APT 1008
SILVER SPRING MD
20906-7606
US

IV. Provider business mailing address

3210 N LEISURE WORLD BLVD APT 1008
SILVER SPRING MD
20906-7606
US

V. Phone/Fax

Practice location:
  • Phone: 301-633-3000
  • Fax:
Mailing address:
  • Phone: 301-633-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025042602
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: