Provider Demographics
NPI:1376018069
Name:SYLVESTER, NGANG SOH
Entity Type:Individual
Prefix:
First Name:NGANG
Middle Name:SOH
Last Name:SYLVESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SYLVESTER
Other - Middle Name:NGANG
Other - Last Name:SOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 CHARLOTTE DR APT 101
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2126
Mailing Address - Country:US
Mailing Address - Phone:240-547-8167
Mailing Address - Fax:
Practice Address - Street 1:1221 TAYLOR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5617
Practice Address - Country:US
Practice Address - Phone:202-464-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13862374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty