Provider Demographics
NPI:1104209360
Name:TEKA, MELVIS
Entity Type:Individual
Prefix:
First Name:MELVIS
Middle Name:
Last Name:TEKA
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 1:2400 QUEENS CHAPEL RD APT 207
Mailing Address - Street 2:
Mailing Address - City:WEST HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3632
Mailing Address - Country:US
Mailing Address - Phone:301-851-1228
Mailing Address - Fax:
Practice Address - Street 1:2400 QUEENS CHAPEL RD APT 207
Practice Address - Street 2:
Practice Address - City:WEST HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3632
Practice Address - Country:US
Practice Address - Phone:301-851-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide