Healthcare Provider Details

I. General information

NPI: 1255023610
Provider Name (Legal Business Name): TSEDAL ARAYA GEBREMARIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E WEST HWY APT 414
SILVER SPRING MD
20910-3238
US

IV. Provider business mailing address

1400 E WEST HWY APT 414
SILVER SPRING MD
20910-3238
US

V. Phone/Fax

Practice location:
  • Phone: 315-572-9327
  • Fax:
Mailing address:
  • Phone: 315-572-9327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberA00201407
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: