Healthcare Provider Details

I. General information

NPI: 1932783925
Provider Name (Legal Business Name): SOLANGE NYUYKI DZERLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 ELTON RD
SILVER SPRING MD
20903-1757
US

IV. Provider business mailing address

1771 ELTON RD
SILVER SPRING MD
20903-1757
US

V. Phone/Fax

Practice location:
  • Phone: 240-636-0047
  • Fax:
Mailing address:
  • Phone: 240-636-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA2000032
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: