Healthcare Provider Details

I. General information

NPI: 1992635130
Provider Name (Legal Business Name): NAOMI TANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 15TH ST NE
WASHINGTON DC
20002-4508
US

IV. Provider business mailing address

5006 69TH AVE
RIVERDALE MD
20737-1795
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number500339144
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: