Provider Demographics
NPI:1124874581
Name:LEKEAFAC, MBUNYA SIDONIE
Entity type:Individual
Prefix:
First Name:MBUNYA
Middle Name:SIDONIE
Last Name:LEKEAFAC
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 1:3320 DODGE PARK RD APT 202
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2116
Mailing Address - Country:US
Mailing Address - Phone:240-663-1852
Mailing Address - Fax:
Practice Address - Street 1:7826 EASTERN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1324
Practice Address - Country:US
Practice Address - Phone:240-663-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide