Provider Demographics
NPI:1245591411
Name:MBAZANG, SKYYDO C (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:SKYYDO
Middle Name:C
Last Name:MBAZANG
Suffix:
Gender:M
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:SKYYDO
Other - Middle Name:C
Other - Last Name:MBAZANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 KENNEDY ST NW APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6521
Mailing Address - Country:US
Mailing Address - Phone:240-491-7465
Mailing Address - Fax:
Practice Address - Street 1:5819 7TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2007
Practice Address - Country:US
Practice Address - Phone:240-481-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker