Provider Demographics
NPI:1245745702
Name:AMAAZEE EPSE MBAH, STEPHANIE SW
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SW
Last Name:AMAAZEE EPSE MBAH
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 1:8423 GREENBELT RD APT T2
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2512
Mailing Address - Country:US
Mailing Address - Phone:240-810-4377
Mailing Address - Fax:
Practice Address - Street 1:6223 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-506-1396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC12786374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$Medicaid