Provider Demographics
NPI:1386327419
Name:KETUNZE, SYLVIA IV
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:
Last Name:KETUNZE
Suffix:IV
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 1:9795 GOOD LUCK RD APT 10
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3346
Mailing Address - Country:US
Mailing Address - Phone:240-615-6351
Mailing Address - Fax:
Practice Address - Street 1:7826 EASTERN AVE NW STE LL14
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1328
Practice Address - Country:US
Practice Address - Phone:240-615-6351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator