Healthcare Provider Details

I. General information

NPI: 1104594639
Provider Name (Legal Business Name): DEL-MAH MEDICAL & PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ENGLISH TURN DR
SILVER SPRING MD
20904-7341
US

IV. Provider business mailing address

13101 ENGLISH TURN DR
SILVER SPRING MD
20904-7341
US

V. Phone/Fax

Practice location:
  • Phone: 301-807-6957
  • Fax:
Mailing address:
  • Phone: 301-807-6957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PRUDENCE MANCHO
Title or Position: OWNER
Credential: CRNP
Phone: 301-807-6957