Mudita Living LLC.

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

MUDITA LIVING LLC.

Practice address

1202 E Holly Ave
Sterling, VA 20164-2612

Phone

(571) 449-0853

NPI assigned

Oct 7, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Vandana Ponnala

Title

Director

Phone

(571) 449-0853

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665100800000",
    "number": "1144945528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23699 HEATHER MEWS DR",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201481812",
            "telephone_number": "571-449-0853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 E HOLLY AVE",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201642612",
            "telephone_number": "571-449-0853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUDITA LIVING LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-07",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A",
        "authorized_official_last_name": "PONNALA",
        "authorized_official_first_name": "VANDANA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "571-449-0853",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://vadbhdsprod.glsuite.us/GLSuiteWeb/Clients/vadbhds/Private/LoginDashboard/Login.aspx",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1202 E Holly Ave",
            "city": "Sterling",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201642612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Sterling, VA
• Providers in Sterling, VA by specialty
• Developmental Disabilities Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.