Provider Demographics
NPI:1649728775
Name:DANESHFOROUZ, JACQUELYN VILLAGOMEZ (PHYSICIAN ASSISTANT)
Entity type:Individual
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First Name:JACQUELYN
Middle Name:VILLAGOMEZ
Last Name:DANESHFOROUZ
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:7305 HANOVER PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2030
Mailing Address - Country:US
Mailing Address - Phone:301-982-7900
Mailing Address - Fax:301-982-4465
Practice Address - Street 1:7305 HANOVER PKWY STE A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3665
Practice Address - Country:US
Practice Address - Phone:301-982-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2025-06-30
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant