Provider Demographics
NPI:1447906862
Name:ROBERTS, NYANJE MOIYATU MADONA
Entity type:Individual
Prefix:
First Name:NYANJE MOIYATU
Middle Name:MADONA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOIYATU
Other - Middle Name:MADONA
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9320 LAWSON LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5829
Mailing Address - Country:US
Mailing Address - Phone:301-204-3624
Mailing Address - Fax:
Practice Address - Street 1:11921 BOURNEFIELD WAY STE A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7815
Practice Address - Country:US
Practice Address - Phone:301-578-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician