MEDICARE: SUZANNE SYVIE NGO NGUIDJEL

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	374U00000X	Home Health Aide	HHA200002647	DC

General Provider Information

NPI Number	:	1194577684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE SYVIE NGO NGUIDJEL

Provider Business Mailing Address
First Line	:	10717 VENETIA MILL CIR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1568
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10717 VENETIA MILL CIR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1568
Country	:	US
Telephone Number	:	240-413-9755
Fax Number	:

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

Provider Enumeration Date	:	04/05/2024
Last Update Date	:	04/05/2024

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