Provider Demographics
NPI:1558659144
Name:NUNES, CARLEYNA MARIAH DANCING STAR (MD)
Entity Type:Individual
Prefix:
First Name:CARLEYNA
Middle Name:MARIAH DANCING STAR
Last Name:NUNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:6355 WALKER LN STE 508
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3251
Practice Address - Country:US
Practice Address - Phone:703-971-7633
Practice Address - Fax:703-971-0997
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72602207V00000X
AZ50034207V00000X
VA0101260851207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5372Medicaid
AZR72602OtherMEDICAL LICENSE NUMBER
VA1558659144Medicaid