Provider Demographics
NPI:1437603420
Name:YENCHI, ELIOT TITATAH
Entity Type:Individual
Prefix:
First Name:ELIOT
Middle Name:TITATAH
Last Name:YENCHI
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 1:2403 BROOKE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1861
Mailing Address - Country:US
Mailing Address - Phone:240-464-5043
Mailing Address - Fax:
Practice Address - Street 1:2403 BROOKE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1861
Practice Address - Country:US
Practice Address - Phone:240-464-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide