Provider Demographics
NPI:1376427948
Name:MANDENG, GERTRUDE KYLIANE
Entity type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:KYLIANE
Last Name:MANDENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 KAREN ELAINE DR APT 1112
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4116
Mailing Address - Country:US
Mailing Address - Phone:615-881-8043
Mailing Address - Fax:
Practice Address - Street 1:6323 GEORGIA AVE NW STE 106
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1101
Practice Address - Country:US
Practice Address - Phone:202-545-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator