Healthcare Provider Details

I. General information

NPI: 1568070415
Provider Name (Legal Business Name): SELAM WOLDETENSAY DAGNACHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 14TH ST NW APT 431
WASHINGTON DC
20010-1339
US

IV. Provider business mailing address

3500 14TH ST NW APT 431
WASHINGTON DC
20010-1339
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-9042
  • Fax:
Mailing address:
  • Phone: 202-476-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: