MEDICARE: MIGUELLE NZOMENE TADZONG

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	171M00000X	Case Manager/Care Coordinator
2	374U00000X	Home Health Aide		DC

General Provider Information

NPI Number	:	1811838857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUELLE NZOMENE TADZONG

Provider Business Mailing Address
First Line	:	3508 HUBBARD RD APT 101
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-2076
Country	:	US
Telephone Number	:	240-955-8638
Fax Number	:	240-955-8638

Provider Business Practice Location Address
First Line	:	3508 HUBBARD RD APT 101
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-2076
Country	:	US
Telephone Number	:	240-955-8638
Fax Number	:	240-955-8638

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

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/28/2026

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