Provider Demographics
NPI:1043766058
Name:AMANDONG, ASHIME A
Entity type:Individual
Prefix:
First Name:ASHIME
Middle Name:A
Last Name:AMANDONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ASHIME
Other - Middle Name:A
Other - Last Name:AMANDONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1401 MERGANSER CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7017
Mailing Address - Country:US
Mailing Address - Phone:202-971-6041
Mailing Address - Fax:
Practice Address - Street 1:1401 MERGANSER CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7017
Practice Address - Country:US
Practice Address - Phone:202-971-6041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12361374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide