Provider Demographics
NPI:1700687969
Name:FELDMANN, MALLORY AVIVA (MSN, CRNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:AVIVA
Last Name:FELDMANN
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 OAKDALE DR APT 408
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4614
Mailing Address - Country:US
Mailing Address - Phone:240-205-6180
Mailing Address - Fax:
Practice Address - Street 1:15245 SHADY GROVE RD STE 150
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7210
Practice Address - Country:US
Practice Address - Phone:301-869-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR249802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily