MEDICARE: OCTAVIE MAYOUMO SEPDEU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R239901	MD

General Provider Information

NPI Number	:	1215356860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OCTAVIE MAYOUMO SEPDEU

Provider Business Mailing Address
First Line	:	8108 ELORA LN
Second Line	:
City	:	BRANDYWINE
State	:	MD
Zip	:	20613-5748
Country	:	US
Telephone Number	:	240-615-7685
Fax Number	:

Provider Business Practice Location Address
First Line	:	11890 HEALING WAY
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7917
Country	:	US
Telephone Number	:	240-637-5573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	01/26/2026

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Directions to “ OCTAVIE MAYOUMO SEPDEU ” Practice Location

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