Provider Demographics
NPI:1013389758
Name:AYENA, ADJO
Entity Type:Individual
Prefix:
First Name:ADJO
Middle Name:
Last Name:AYENA
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 1:630 SHERIDAN ST
Mailing Address - Street 2:#212
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3262
Mailing Address - Country:US
Mailing Address - Phone:240-481-7957
Mailing Address - Fax:
Practice Address - Street 1:630 SHERIDAN ST
Practice Address - Street 2:#212
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3262
Practice Address - Country:US
Practice Address - Phone:240-481-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide