Provider Demographics
NPI:1538615604
Name:MASILELA, THANDI
Entity type:Individual
Prefix:
First Name:THANDI
Middle Name:
Last Name:MASILELA
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 1:7542 BELLE GRAE DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-6417
Mailing Address - Country:US
Mailing Address - Phone:305-799-2679
Mailing Address - Fax:
Practice Address - Street 1:17340 QUAKER LN
Practice Address - Street 2:
Practice Address - City:SANDY SPRING
Practice Address - State:MD
Practice Address - Zip Code:20860-1247
Practice Address - Country:US
Practice Address - Phone:301-924-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01357L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist