Healthcare Provider Details

I. General information

NPI: 1124961057
Provider Name (Legal Business Name): ROSELINE NYAKAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 LOCKWOOD DR
SILVER SPRING MD
20901-4551
US

IV. Provider business mailing address

11200 LOCKWOOD DR
SILVER SPRING MD
20901-4551
US

V. Phone/Fax

Practice location:
  • Phone: 240-801-0420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: