Provider Demographics
NPI:1699465542
Name:AMEGAWOVO, ESSI SYLVIE
Entity type:Individual
Prefix:
First Name:ESSI
Middle Name:SYLVIE
Last Name:AMEGAWOVO
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 1:2631 NICHOLSON ST APT 202
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2658
Mailing Address - Country:US
Mailing Address - Phone:315-572-9327
Mailing Address - Fax:
Practice Address - Street 1:2631 NICHOLSON ST APT 202
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2658
Practice Address - Country:US
Practice Address - Phone:315-572-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20231053374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide