MEDICARE: GRACE STEPHANIE NAMBO-RENOMBO

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	106E00000X	Assistant Behavior Analyst		VA

General Provider Information

NPI Number	:	1972438927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE STEPHANIE NAMBO-RENOMBO

Provider Business Mailing Address
First Line	:	8300 GREENSBORO DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3605
Country	:	US
Telephone Number	:	571-777-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 GREENSBORO DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3605
Country	:	US
Telephone Number	:	571-777-9200
Fax Number	:

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

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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Directions to “ GRACE STEPHANIE NAMBO-RENOMBO ” Practice Location

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