MEDICARE: SYLPHIDE LAFORET MOUNKENG NDONZOU

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	374U00000X	Home Health Aide	HHA13565	DC

General Provider Information

NPI Number	:	1841797180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLPHIDE LAFORET MOUNKENG NDONZOU

Provider Business Mailing Address
First Line	:	8405 MYRTLE AVE
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20715-4550
Country	:	US
Telephone Number	:	240-478-0533
Fax Number	:

Provider Business Practice Location Address
First Line	:	8405 MYRTLE AVE
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20715-4550
Country	:	US
Telephone Number	:	240-478-0533
Fax Number	:

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

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	04/12/2018

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