Provider Demographics
NPI:1528678216
Name:ITA MEYEH NDZEWIYI, FNU
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:ITA MEYEH NDZEWIYI
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 1:5303 85TH AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3231
Mailing Address - Country:US
Mailing Address - Phone:301-728-2216
Mailing Address - Fax:
Practice Address - Street 1:3730 MINNESOTA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2667
Practice Address - Country:US
Practice Address - Phone:202-301-5204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide