Healthcare Provider Details

I. General information

NPI: 1386500064
Provider Name (Legal Business Name): VANESSA NAMUGALU
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 GIST AVE
SILVER SPRING MD
20910-5234
US

IV. Provider business mailing address

708 GIST AVE
SILVER SPRING MD
20910-5234
US

V. Phone/Fax

Practice location:
  • Phone: 202-412-3666
  • Fax: 301-565-9621
Mailing address:
  • Phone: 202-412-3666
  • Fax: 301-565-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR221092
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: