Provider Demographics
NPI:1922536960
Name:SUVARNASUDDHI, KHANITA (DC, L AC)
Entity Type:Individual
Prefix:
First Name:KHANITA
Middle Name:
Last Name:SUVARNASUDDHI
Suffix:
Gender:F
Credentials:DC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20302 SCENERY DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6036
Mailing Address - Country:US
Mailing Address - Phone:240-654-2608
Mailing Address - Fax:
Practice Address - Street 1:23330 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-9704
Practice Address - Country:US
Practice Address - Phone:240-702-6413
Practice Address - Fax:888-972-7952
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03929111N00000X
MDU02447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor