Healthcare Provider Details

I. General information

NPI: 1407703978
Provider Name (Legal Business Name): IVAN DJIEYA DJIEYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RITCHIE AVE APT 2
SILVER SPRING MD
20910-5129
US

IV. Provider business mailing address

20 RITCHIE AVE APT 2
SILVER SPRING MD
20910-5129
US

V. Phone/Fax

Practice location:
  • Phone: 240-601-6790
  • Fax:
Mailing address:
  • Phone: 240-601-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: