Provider Demographics
NPI:1063921351
Name:BEREYE, MECHEBEZ FEKADU
Entity type:Individual
Prefix:
First Name:MECHEBEZ
Middle Name:FEKADU
Last Name:BEREYE
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 1:8401 MANCHESTER RD APT 501
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4336
Mailing Address - Country:US
Mailing Address - Phone:240-644-8045
Mailing Address - Fax:
Practice Address - Street 1:8401 MANCHESTER RD APT 501
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4336
Practice Address - Country:US
Practice Address - Phone:240-644-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1007588164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty