Provider Demographics
NPI:1821746520
Name:GUNAWAN, FELICIA (MASTERS OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:GUNAWAN
Suffix:
Gender:F
Credentials:MASTERS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15726 TROLLEY LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1278
Mailing Address - Country:US
Mailing Address - Phone:240-614-6891
Mailing Address - Fax:
Practice Address - Street 1:15726 TROLLEY LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1278
Practice Address - Country:US
Practice Address - Phone:240-614-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist