Provider Demographics
NPI:1699107649
Name:SUILEBHAN, MAURA ANNE STADEM
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:ANNE STADEM
Last Name:SUILEBHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3116
Mailing Address - Country:US
Mailing Address - Phone:202-744-4833
Mailing Address - Fax:
Practice Address - Street 1:1900 L ST NW
Practice Address - Street 2:SUITE #607
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5002
Practice Address - Country:US
Practice Address - Phone:202-520-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02038224Z00000X
DCOTA100000255224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant