MEDICARE: TEMBUH SONITA MANYONG I

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	HHA12059	DC

General Provider Information

NPI Number	:	1932557469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEMBUH SONITA MANYONG I

Provider Business Mailing Address
First Line	:	1014 60TH AVE
Second Line	:
City	:	FAIRMOUNT HEIGHTS
State	:	MD
Zip	:	20743-1420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 60TH AVE
Second Line	:
City	:	FAIRMOUNT HEIGHTS
State	:	MD
Zip	:	20743-1420
Country	:	US
Telephone Number	:	240-938-8650
Fax Number	:

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

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	04/30/2018

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Directions to “ TEMBUH SONITA MANYONG I ” Practice Location

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