Healthcare Provider Details

I. General information

NPI: 1790296994
Provider Name (Legal Business Name): AUDRINE ORLIANE DJOUDJA SOPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

12113 QUADRILLE LN
BOWIE MD
20720-4384
US

V. Phone/Fax

Practice location:
  • Phone: 202-489-0615
  • Fax:
Mailing address:
  • Phone: 240-643-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13107
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: