Provider Demographics
NPI:1689261976
Name:PESSU, EDIDIONG
Entity Type:Individual
Prefix:MRS
First Name:EDIDIONG
Middle Name:
Last Name:PESSU
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DIDI
Other - Middle Name:
Other - Last Name:PESSU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2685 ORCHARD ORIOLE WAY
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3120
Mailing Address - Country:US
Mailing Address - Phone:240-855-8759
Mailing Address - Fax:
Practice Address - Street 1:2685 ORCHARD ORIOLE WAY
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3120
Practice Address - Country:US
Practice Address - Phone:240-855-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4677P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health