Healthcare Provider Details

I. General information

NPI: 1487509329
Provider Name (Legal Business Name): LETICIANE TATIANA CHAMAKE TCHAKOUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7769 RIVERDALE RD APT 103
NEW CARROLLTON MD
20784-3931
US

IV. Provider business mailing address

7769 RIVERDALE RD APT 103
NEW CARROLLTON MD
20784-3931
US

V. Phone/Fax

Practice location:
  • Phone: 240-389-7128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: