Provider Demographics
NPI:1346894136
Name:NDOMBOU, AUDREY ARMELLE
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ARMELLE
Last Name:NDOMBOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:ARMELLE
Other - Last Name:NDOMBOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1640 WASHINGTON ST BOSTON
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-369-1560
Mailing Address - Fax:
Practice Address - Street 1:1640 WASHINGTON ST BOSTON
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-369-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator