Provider Demographics
NPI:1134820020
Name:TAYE, EDEN MULUNEH (DNP)
Entity type:Individual
Prefix:DR
First Name:EDEN
Middle Name:MULUNEH
Last Name:TAYE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1914
Mailing Address - Country:US
Mailing Address - Phone:301-318-1859
Mailing Address - Fax:
Practice Address - Street 1:9002 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1914
Practice Address - Country:US
Practice Address - Phone:301-318-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170345363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health