Healthcare Provider Details

I. General information

NPI: 1265379051
Provider Name (Legal Business Name): NERISSA TEDONGFACK ASOBONTUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9216 DAVIDSON ST
COLLEGE PARK MD
20740-3903
US

IV. Provider business mailing address

9216 DAVIDSON ST
COLLEGE PARK MD
20740-3903
US

V. Phone/Fax

Practice location:
  • Phone: 380-261-9363
  • Fax:
Mailing address:
  • Phone: 380-261-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: