Provider Demographics
NPI:1821787656
Name:BYAMUNGU, AMOS
Entity Type:Individual
Prefix:MR
First Name:AMOS
Middle Name:
Last Name:BYAMUNGU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 EMERSON ST APT 104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3263
Mailing Address - Country:US
Mailing Address - Phone:701-264-9203
Mailing Address - Fax:
Practice Address - Street 1:13 EMERSON ST APT 104
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3263
Practice Address - Country:US
Practice Address - Phone:701-264-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care