Healthcare Provider Details

I. General information

NPI: 1003552928
Provider Name (Legal Business Name): AMBISAH SUSAN ATONGSANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN AMBISAH

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10804 RIVER OAKS TER
BOWIE MD
20721-2355
US

IV. Provider business mailing address

10804 RIVER OAKS TER
BOWIE MD
20721-2355
US

V. Phone/Fax

Practice location:
  • Phone: 202-940-3605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200001758
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: