Provider Demographics
NPI:1609614312
Name:GLADYS, MBAYI ACHA
Entity type:Individual
Prefix:
First Name:MBAYI
Middle Name:ACHA
Last Name:GLADYS
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 1:2500 SAINT JOSEPHS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2995
Mailing Address - Country:US
Mailing Address - Phone:515-371-2031
Mailing Address - Fax:
Practice Address - Street 1:2500 SAINT JOSEPHS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2995
Practice Address - Country:US
Practice Address - Phone:515-371-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide