Healthcare Provider Details

I. General information

NPI: 1386354835
Provider Name (Legal Business Name): MATILDA DJIN NDIFON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 KENNEDY ST NW
WASHINGTON DC
20011-3136
US

IV. Provider business mailing address

11548 FEBRUARY CIR APT 304
SILVER SPRING MD
20904-3903
US

V. Phone/Fax

Practice location:
  • Phone: 202-313-7283
  • Fax:
Mailing address:
  • Phone: 240-467-8112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: