Provider Demographics
NPI:1477079127
Name:MENGESHA, SEBELE FESSSEHA
Entity Type:Individual
Prefix:
First Name:SEBELE
Middle Name:FESSSEHA
Last Name:MENGESHA
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 1:1319 COLUMBIA RD NW APT 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4919
Mailing Address - Country:US
Mailing Address - Phone:202-486-8674
Mailing Address - Fax:
Practice Address - Street 1:1010 VERMONT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4902
Practice Address - Country:US
Practice Address - Phone:202-698-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC$$$$$$$$$Medicaid