Provider Demographics
NPI:1760602544
Name:MANSARAY, MEMUNA
Entity Type:Individual
Prefix:MRS
First Name:MEMUNA
Middle Name:
Last Name:MANSARAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEMUNA
Other - Middle Name:
Other - Last Name:TUNKARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 LAVENHAM PL
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3469
Mailing Address - Country:US
Mailing Address - Phone:202-251-1742
Mailing Address - Fax:
Practice Address - Street 1:11 LAVENHAM PL
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3469
Practice Address - Country:US
Practice Address - Phone:202-251-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC670343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)