Provider Demographics
NPI:1134682990
Name:MANDOPELADEPSEEPANTY, ANASTASIA (HHA)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:
Last Name:MANDOPELADEPSEEPANTY
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 METZEROTT RD APT 1502
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3451
Mailing Address - Country:US
Mailing Address - Phone:240-601-6283
Mailing Address - Fax:
Practice Address - Street 1:1836 METZEROTT RD APT 1502
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3451
Practice Address - Country:US
Practice Address - Phone:240-601-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14381374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide