MEDICARE: SUZZY MAYANG-NKWANYUO

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	3747P1801X	Personal Care Attendant		DC
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1801552187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZZY MAYANG-NKWANYUO

Provider Business Mailing Address
First Line	:	13101 KEVERTON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1844
Country	:	US
Telephone Number	:	678-862-3970
Fax Number	:

Provider Business Practice Location Address
First Line	:	13101 KEVERTON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1844
Country	:	US
Telephone Number	:	678-862-3970
Fax Number	:

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

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/16/2023

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