Provider Demographics
NPI:1972764801
Name:MYENI, THANDEKA (MD)
Entity Type:Individual
Prefix:DR
First Name:THANDEKA
Middle Name:
Last Name:MYENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 MARTIN LUTHER KING JR AVE SE STE 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-7033
Mailing Address - Country:US
Mailing Address - Phone:202-889-5700
Mailing Address - Fax:202-610-1861
Practice Address - Street 1:2041 MARTIN LUTHER KING JR AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7033
Practice Address - Country:US
Practice Address - Phone:202-889-5700
Practice Address - Fax:202-610-1861
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14959207W00000X
MDD74797207W00000X
DCMD040967207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC012845502Medicaid
DC073072308Medicaid