Provider Demographics
NPI:1528800216
Name:ACHU, SIMON NWATI
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:NWATI
Last Name:ACHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10718 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4942
Mailing Address - Country:US
Mailing Address - Phone:612-867-1566
Mailing Address - Fax:
Practice Address - Street 1:10718 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4942
Practice Address - Country:US
Practice Address - Phone:612-867-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator