Provider Demographics
NPI:1700775699
Name:LEDESMA DE JESUS, MIOSOTIS L
Entity type:Individual
Prefix:
First Name:MIOSOTIS
Middle Name:L
Last Name:LEDESMA DE JESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9658 BALTIMORE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1346
Mailing Address - Country:US
Mailing Address - Phone:202-695-9666
Mailing Address - Fax:
Practice Address - Street 1:9658 BALTIMORE AVE STE 300
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1346
Practice Address - Country:US
Practice Address - Phone:202-695-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide