Provider Demographics
NPI:1336507524
Name:TANGOALEM, CYNTHIA ANUBOWOH
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANUBOWOH
Last Name:TANGOALEM
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 1:9633 UTICA PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5449
Mailing Address - Country:US
Mailing Address - Phone:240-305-5259
Mailing Address - Fax:
Practice Address - Street 1:9633 UTICA PL
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:MD
Practice Address - Zip Code:20774-5449
Practice Address - Country:US
Practice Address - Phone:240-305-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11508374U00000X
MD09471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No374U00000XNursing Service Related ProvidersHome Health Aide