Provider Demographics
NPI:1225645823
Name:NGANDHI, BERTHE LILIANE
Entity Type:Individual
Prefix:
First Name:BERTHE
Middle Name:LILIANE
Last Name:NGANDHI
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 1:3418 ROBEY TER APT 203
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7773
Mailing Address - Country:US
Mailing Address - Phone:301-538-8475
Mailing Address - Fax:
Practice Address - Street 1:3418 ROBEY TER APT 203
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7773
Practice Address - Country:US
Practice Address - Phone:301-538-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR01423225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist