Healthcare Provider Details

I. General information

NPI: 1952047656
Provider Name (Legal Business Name): DORA YEBOAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4834 AUTUMN GLORY WAY
CHANTILLY VA
20151-2352
US

IV. Provider business mailing address

4834 AUTUMN GLORY WAY
CHANTILLY VA
20151-2352
US

V. Phone/Fax

Practice location:
  • Phone: 703-263-0861
  • Fax: 703-968-9293
Mailing address:
  • Phone: 703-263-0861
  • Fax: 703-968-3942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHCO-0000896
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberHCO-0000896
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHCO-0000896
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: