Provider Demographics
NPI:1467074039
Name:MBAYA, SAMMY MUTHORA SR (HCA)
Entity Type:Individual
Prefix:MR
First Name:SAMMY
Middle Name:MUTHORA
Last Name:MBAYA
Suffix:SR
Gender:M
Credentials:HCA
Other - Prefix:MR
Other - First Name:SAMMY
Other - Middle Name:MUTHORA
Other - Last Name:MBAYA
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:HCA
Mailing Address - Street 1:2018 156TH AVE NE STE 2018156
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3825
Mailing Address - Country:US
Mailing Address - Phone:425-440-2727
Mailing Address - Fax:
Practice Address - Street 1:2018 156TH AVE NE STE 2018156
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3825
Practice Address - Country:US
Practice Address - Phone:425-440-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60992210253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA842212536OtherNON MEDICAL
WAIFS.FS.60992210OtherIN- HOME CARE AGENCY