Healthcare Provider Details

I. General information

NPI: 1447798244
Provider Name (Legal Business Name): ISATA GBOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825D RIVERDALE RD RIVERADLE APT 202 D
RIVERDALE MD
20737-1839
US

IV. Provider business mailing address

6825D RIVERDALE RD RIVERADLE APT 202 D
RIVERDALE MD
20737-1839
US

V. Phone/Fax

Practice location:
  • Phone: 240-383-7333
  • Fax:
Mailing address:
  • Phone: 240-383-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12641
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: