MEDICARE: ODETTE ANIMBOM

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	106S00000X	Behavior Technician
2	374U00000X	Home Health Aide		DC

General Provider Information

NPI Number	:	1720942923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODETTE ANIMBOM

Provider Business Mailing Address
First Line	:	915 ANDEAN GOOSE WAY
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-7127
Country	:	US
Telephone Number	:	240-304-1137
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 ANDEAN GOOSE WAY
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-7127
Country	:	US
Telephone Number	:	240-304-1137
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	04/02/2026

Similar Medicare Providers

1003756099 — ZAMAIAH DANESHA DENIS
Practice Location Address:

9701 APOLLO DR STE 100
UPPER MARLBORO, MD
20774-4785

Practice Phone: 301-456-4787
Practice Fax:

1821938671 — ALICE MARIE PARKS
Practice Location Address:

9750 APOLLO DR # B29
UPPER MARLBORO, MD
20774-4924

Practice Phone: 240-795-2883
Practice Fax:

1386524635 — MEDINEEDS SERVICES LLC
Practice Location Address:

11429 DUNLORING PL
UPPER MARLBORO, MD
20774-5758

Practice Phone: 703-972-5004
Practice Fax: 703-995-4846

1306787502 — PHILIPA TIFANG
Practice Location Address:

3205 WINTER PARK CT
UPPER MARLBORO, MD
20774-7550

Practice Phone: 202-439-0038
Practice Fax:

1700737152 — BERTILA AKEGEH AZANE
Practice Location Address:

12902 KEVERTON DR
UPPER MARLBORO, MD
20774-1837

Practice Phone: 240-484-2218
Practice Fax:

1992781868 — KANESSIA SHEPARD MA, CCC-SLP
Practice Location Address:

9716 LAKE POINTE CT APT 101
UPPER MARLBORO, MD
20774-4714

Practice Phone: 240-788-7089
Practice Fax: 240-788-7089

Directions to “ ODETTE ANIMBOM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.