Provider Demographics
NPI:1710302328
Name:NDAM, DILYS ACHA
Entity Type:Individual
Prefix:
First Name:DILYS
Middle Name:ACHA
Last Name:NDAM
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 1:6836 TREXLER RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3777
Mailing Address - Country:US
Mailing Address - Phone:240-467-7567
Mailing Address - Fax:202-450-3109
Practice Address - Street 1:6836 TREXLER RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3777
Practice Address - Country:US
Practice Address - Phone:240-467-7567
Practice Address - Fax:202-450-3109
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10378374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide