MEDICARE: DADDY BRIAN NGWA AFANWI

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1174320360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DADDY BRIAN NGWA AFANWI

Provider Business Mailing Address
First Line	:	15378 BALD EAGLE LN
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3739
Country	:	US
Telephone Number	:	571-602-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	4565 DAISY REID AVE
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-5670
Country	:	US
Telephone Number	:	571-602-1888
Fax Number	:

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

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	02/26/2025

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