=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235004185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LARAYDIANCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2025
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8600 FOUNDRY STREET NEW WEAVE LOFT SUITE 043 MAILBOX #2006
-----------------------------------------------------
City | SAVAGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-510-7055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8600 FOUNDRY STREET NEW WEAVE LOFT SUITE 043 MAILBOX #2006
-----------------------------------------------------
City | SAVAGE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-510-7055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. LARAY ABRAHAM
-----------------------------------------------------
Credential | RDH, LE, IHC, LMT,CD
-----------------------------------------------------
Telephone | 443-510-7055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------