Provider Demographics
NPI:1598374175
Name:NDIAYE, DEMBA
Entity Type:Individual
Prefix:MR
First Name:DEMBA
Middle Name:
Last Name:NDIAYE
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 1:9727 MOUNT PISGAH RD APT 1101
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2028
Mailing Address - Country:US
Mailing Address - Phone:202-643-6323
Mailing Address - Fax:
Practice Address - Street 1:9727 MOUNT PISGAH RD APT 1101
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2028
Practice Address - Country:US
Practice Address - Phone:202-643-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health