Provider Demographics
NPI:1821854100
Name:GEBREYES, SURAFEL KONU
Entity Type:Individual
Prefix:
First Name:SURAFEL
Middle Name:KONU
Last Name:GEBREYES
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 1:1444 ROCK CREEK FORD RD NW APT 213
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1727
Mailing Address - Country:US
Mailing Address - Phone:202-817-8525
Mailing Address - Fax:
Practice Address - Street 1:1444 ROCK CREEK FORD RD NW APT 213
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1727
Practice Address - Country:US
Practice Address - Phone:202-817-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide