Healthcare Provider Details

I. General information

NPI: 1366300386
Provider Name (Legal Business Name): GAFOBEA MARIELANDRIN NAHYAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 NEWTON ST
HYATTSVILLE MD
20784-1156
US

IV. Provider business mailing address

5506 NEWTON ST
HYATTSVILLE MD
20784-1156
US

V. Phone/Fax

Practice location:
  • Phone: 202-751-8288
  • Fax:
Mailing address:
  • Phone: 202-751-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberNA0000814727
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: