Provider Demographics
NPI:1508250473
Name:MANYI ELEANOR ESPE AK, ELANGO (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:ELANGO
Middle Name:
Last Name:MANYI ELEANOR ESPE AK
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11754 S LAUREL DR
Mailing Address - Street 2:APT 4C
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2948
Mailing Address - Country:US
Mailing Address - Phone:240-838-9415
Mailing Address - Fax:
Practice Address - Street 1:11754 S LAUREL DR
Practice Address - Street 2:APT4 C
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2948
Practice Address - Country:US
Practice Address - Phone:240-838-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11145374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide