Healthcare Provider Details

I. General information

NPI: 1235074923
Provider Name (Legal Business Name): RX-BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 TIMBERLY CT
MC LEAN VA
22102-2522
US

IV. Provider business mailing address

PO BOX 3053
MC LEAN VA
22103-3053
US

V. Phone/Fax

Practice location:
  • Phone: 240-499-6906
  • Fax:
Mailing address:
  • Phone: 240-499-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VANDANA MEDURI
Title or Position: OWNER
Credential:
Phone: 240-499-6906