Healthcare Provider Details

I. General information

NPI: 1679478986
Provider Name (Legal Business Name): HAWANATU LATISHA BANGURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 N ST NW STE A1
WASHINGTON DC
20005-2817
US

IV. Provider business mailing address

915 SILVER SPRING AVE APT 626
SILVER SPRING MD
20910-5124
US

V. Phone/Fax

Practice location:
  • Phone: 240-645-5899
  • Fax:
Mailing address:
  • Phone: 240-645-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number2855157
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: