Provider Demographics
NPI:1891280582
Name:MONDEA NKONGANYI, LESLIE
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:
Last Name:MONDEA NKONGANYI
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 1:10917 SPYGLASS HL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2342
Mailing Address - Country:US
Mailing Address - Phone:240-559-6604
Mailing Address - Fax:
Practice Address - Street 1:2512 24TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:202-883-8340
Practice Address - Fax:202-832-8341
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13726374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide