MEDICARE: RICKY AZIENGU

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	171M00000X	Case Manager/Care Coordinator
2	3747P1801X	Personal Care Attendant		DC

General Provider Information

NPI Number	:	1639048309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKY AZIENGU

Provider Business Mailing Address
First Line	:	54 JOYCETON WAY
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 JOYCETON WAY
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1400
Country	:	US
Telephone Number	:	301-679-9082
Fax Number	:

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

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	03/09/2026

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Directions to “ RICKY AZIENGU ” Practice Location

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