Provider Demographics
NPI:1770015893
Name:EMENKIA, VALERY
Entity Type:Individual
Prefix:
First Name:VALERY
Middle Name:
Last Name:EMENKIA
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 1:3320 DODGE PARK RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2116
Mailing Address - Country:US
Mailing Address - Phone:240-543-2440
Mailing Address - Fax:
Practice Address - Street 1:3320 DODGE PARK RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2116
Practice Address - Country:US
Practice Address - Phone:240-543-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12669374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide