Healthcare Provider Details

I. General information

NPI: 1376108142
Provider Name (Legal Business Name): FABRIS NEMBO MANYAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 METZEROTT RD APT 301
ADELPHI MD
20783-3444
US

IV. Provider business mailing address

1836 METZEROTT RD APT 301
ADELPHI MD
20783-3444
US

V. Phone/Fax

Practice location:
  • Phone: 202-999-6830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14446
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: