Healthcare Provider Details

I. General information

NPI: 1477258853
Provider Name (Legal Business Name): MR. ABEINWU AMBESI NEBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 CHESHIRE LN
LANHAM MD
20706-4165
US

IV. Provider business mailing address

5106 CHESHIRE LN
LANHAM MD
20706-4165
US

V. Phone/Fax

Practice location:
  • Phone: 240-828-9571
  • Fax:
Mailing address:
  • Phone: 240-828-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMD-10272361905
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: