=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548851595
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIE OPOKU AGYEMAN RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2021
-----------------------------------------------------
Last Update Date | 02/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4470 REGENCY PL STE 106
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20695-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-252-2140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 289 KIRBY ST
-----------------------------------------------------
City | MANASSAS PARK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20111-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | DX5150
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------