Provider Demographics
NPI:1407335342
Name:EPOH MANYAKA, FREDDY
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:
Last Name:EPOH MANYAKA
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 1:6733 NEW HAMPSHIRE AVE APT 1210
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-2862
Mailing Address - Country:US
Mailing Address - Phone:240-877-3004
Mailing Address - Fax:
Practice Address - Street 1:6733 NEW HAMPSHIRE AVE
Practice Address - Street 2:APT.1210
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-2091
Practice Address - Country:US
Practice Address - Phone:240-877-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13881374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$OtherSOCIAL SECURITY ADMINISTRATION