Healthcare Provider Details

I. General information

NPI: 1548851595
Provider Name (Legal Business Name): VALERIE OPOKU AGYEMAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 REGENCY PL STE 106
WHITE PLAINS MD
20695-3085
US

IV. Provider business mailing address

289 KIRBY ST
MANASSAS PARK VA
20111-3401
US

V. Phone/Fax

Practice location:
  • Phone: 240-252-2140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX5150
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: