Healthcare Provider Details

I. General information

NPI: 1295617256
Provider Name (Legal Business Name): MINIF NJOCK AYUK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CRAIN HWY STE 202
WALDORF MD
20601-3190
US

IV. Provider business mailing address

2255 CRAIN HWY STE 202
WALDORF MD
20601-3190
US

V. Phone/Fax

Practice location:
  • Phone: 786-788-5080
  • Fax: 786-788-5084
Mailing address:
  • Phone: 786-788-5080
  • Fax: 786-788-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberMT0162577
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberMT0162577
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: