Healthcare Provider Details

I. General information

NPI: 1093914541
Provider Name (Legal Business Name): MR. FEKADU SHAPA HYBANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2007
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 MONTANA AVE NE
WASHINGTON DC
20018-1202
US

IV. Provider business mailing address

1512 MONTANA AVE NE
WASHINGTON DC
20018-1202
US

V. Phone/Fax

Practice location:
  • Phone: 202-437-6762
  • Fax:
Mailing address:
  • Phone: 202-437-6762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number655
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: