Healthcare Provider Details

I. General information

NPI: 1396397212
Provider Name (Legal Business Name): SYNTICHE HOTOU MEJONANG HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5609 COLUMBIA RD APT 103
COLUMBIA MD
21044-5590
US

IV. Provider business mailing address

5609 COLUMBIA RD APT 103
COLUMBIA MD
21044-5590
US

V. Phone/Fax

Practice location:
  • Phone: 804-550-8337
  • Fax:
Mailing address:
  • Phone: 804-550-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14106
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: