Provider Demographics
NPI:1508127341
Name:SANGWE, KENEDY N
Entity Type:Individual
Prefix:MR
First Name:KENEDY
Middle Name:N
Last Name:SANGWE
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 1:2002 AVENEL RD
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1308
Mailing Address - Country:US
Mailing Address - Phone:240-278-1822
Mailing Address - Fax:
Practice Address - Street 1:2002 AVENEL RD
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1308
Practice Address - Country:US
Practice Address - Phone:240-278-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS520465628974374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide