MEDICARE: JERUSALEM NYIZOFO TUKURA ED.S, NCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1033086632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERUSALEM NYIZOFO TUKURA ED.S, NCSP

Provider Business Mailing Address
First Line	:	7710 HAYNES POINT WAY UNIT E
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-6017
Country	:	US
Telephone Number	:	701-500-9813
Fax Number	:

Provider Business Practice Location Address
First Line	:	8909 RIGGS RD
Second Line	:
City	:	ADELPHI
State	:	MD
Zip	:	20783-1633
Country	:	US
Telephone Number	:	301-408-6860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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