Healthcare Provider Details

I. General information

NPI: 1487481719
Provider Name (Legal Business Name): BENYELLA MUSONG BORIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 MINNESOTA AVENUE
NE WASHINGTON DC
20002-4508
US

IV. Provider business mailing address

6933 LAMONT DR
LANHAM MD
20706-4606
US

V. Phone/Fax

Practice location:
  • Phone: 202-839-5310
  • Fax:
Mailing address:
  • Phone: 240-854-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: