Provider Demographics
NPI:1043657653
Name:AYUK, ALICE O
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:O
Last Name:AYUK
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 1:14000 CASTLE BLVD
Mailing Address - Street 2:609
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4639
Mailing Address - Country:US
Mailing Address - Phone:240-468-2496
Mailing Address - Fax:
Practice Address - Street 1:14000 CASTLE BLVD
Practice Address - Street 2:609
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4639
Practice Address - Country:US
Practice Address - Phone:240-468-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA7101251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health