Healthcare Provider Details

I. General information

NPI: 1891331716
Provider Name (Legal Business Name): SHAMARIAH FINJAP OGU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 55TH AVE
BLADENSBURG MD
20710-1507
US

IV. Provider business mailing address

4203 55TH AVE
BLADENSBURG MD
20710-1507
US

V. Phone/Fax

Practice location:
  • Phone: 202-492-6995
  • Fax:
Mailing address:
  • Phone: 202-492-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: