MEDICARE: SYLEVANUS NKENGAFAC

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	172V00000X	Community Health Worker
2	374U00000X	Home Health Aide	HHA15647	DC
3	171M00000X	Case Manager/Care Coordinator		DC

General Provider Information

NPI Number	:	1104404995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLEVANUS NKENGAFAC

Provider Business Mailing Address
First Line	:	912 DELRAN PL
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-5717
Country	:	US
Telephone Number	:	240-486-6804
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 DELRAN PL
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-5717
Country	:	US
Telephone Number	:	240-486-6804
Fax Number	:

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

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	06/01/2026

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Directions to “ SYLEVANUS NKENGAFAC ” Practice Location

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