Provider Demographics
NPI:1376933242
Name:WHETHO, AYO
Entity Type:Individual
Prefix:
First Name:AYO
Middle Name:
Last Name:WHETHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 LOCKPORT PL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1525
Mailing Address - Country:US
Mailing Address - Phone:240-510-5440
Mailing Address - Fax:
Practice Address - Street 1:7212 LOCKPORT PL
Practice Address - Street 2:SUITE 104
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1525
Practice Address - Country:US
Practice Address - Phone:240-510-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11040374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide