Healthcare Provider Details

I. General information

NPI: 1477919892
Provider Name (Legal Business Name): DELPHINE NGUANYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 67TH AVE
RIVERDALE MD
20737-1765
US

IV. Provider business mailing address

6021 67TH AVE
RIVERDALE MD
20737-1765
US

V. Phone/Fax

Practice location:
  • Phone: 646-385-9271
  • Fax:
Mailing address:
  • Phone: 646-385-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA11787
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: