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NPI Code Detail

MEDICARE: SHELLEY KENNETH MBANWEI

MEDICARE: SHELLEY KENNETH MBANWEI
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
1172V00000XCommunity Health Worker
2171M00000XCase Manager/Care Coordinator
3251S00000XCommunity/Behavioral Health Agency
4374U00000XHome Health Aide140636DC

General Provider Information

NPI Number : 1861753428
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLEY KENNETH MBANWEI
Provider Business Mailing Address
First Line : 7702 QUAINT CT
Second Line :
City : BOWIE
State : MD
Zip : 20720-4316
Country : US
Telephone Number : 202-629-8674
Fax Number :
Provider Business Practice Location Address
First Line : 3300 PENNSYLVANIA AVE SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-2408
Country : US
Telephone Number : 202-878-6626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2012
Last Update Date : 12/06/2023

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