Provider Demographics
NPI:1093608564
Name:MENEDO, MEHARU MATHEWOS
Entity type:Individual
Prefix:
First Name:MEHARU
Middle Name:MATHEWOS
Last Name:MENEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 130TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7136
Mailing Address - Country:US
Mailing Address - Phone:206-775-2063
Mailing Address - Fax:425-332-3501
Practice Address - Street 1:2628 130TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7136
Practice Address - Country:US
Practice Address - Phone:206-775-2063
Practice Address - Fax:425-332-3501
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA758058251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health