Provider Demographics
NPI:1427412543
Name:GHAAH, NELLY SHIYNYUY
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:SHIYNYUY
Last Name:GHAAH
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 1:7000 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1100
Mailing Address - Country:US
Mailing Address - Phone:240-495-4387
Mailing Address - Fax:
Practice Address - Street 1:7000 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1100
Practice Address - Country:US
Practice Address - Phone:240-495-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11916376K00000X
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41705241500Medicaid