Healthcare Provider Details

I. General information

NPI: 1578443537
Provider Name (Legal Business Name): SATYA HEWCHUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WALLACE KOKEB

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PRATT ST FL 8
BALTIMORE MD
21202-3180
US

IV. Provider business mailing address

9900 BOYSENBERRY WAY APT 270
GAITHERSBURG MD
20879-3685
US

V. Phone/Fax

Practice location:
  • Phone: 443-543-9980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: