Provider Demographics
NPI:1508640764
Name:AYUK, TABOT BISONG
Entity Type:Individual
Prefix:
First Name:TABOT
Middle Name:BISONG
Last Name:AYUK
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 1:5409 RIVERDALE RD APT B2
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2369
Mailing Address - Country:US
Mailing Address - Phone:301-467-0042
Mailing Address - Fax:
Practice Address - Street 1:5409 RIVERDALE RD APT B2
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2369
Practice Address - Country:US
Practice Address - Phone:301-467-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide