Provider Demographics
NPI:1881950442
Name:JELVANI, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:JELVANI
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 1:11801 ROCKVILLE PIKE
Mailing Address - Street 2:APARTMENT 1706
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2734
Mailing Address - Country:US
Mailing Address - Phone:240-888-2410
Mailing Address - Fax:
Practice Address - Street 1:11801 ROCKVILLE PIKE
Practice Address - Street 2:APARTMENT 1706
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2734
Practice Address - Country:US
Practice Address - Phone:240-888-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist