Provider Demographics
NPI:1184132243
Name:GIRMAY, AMANUEL
Entity type:Individual
Prefix:
First Name:AMANUEL
Middle Name:
Last Name:GIRMAY
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 1:5228 ILLINOIS AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3904
Mailing Address - Country:US
Mailing Address - Phone:571-635-2761
Mailing Address - Fax:
Practice Address - Street 1:5228 ILLINOIS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3904
Practice Address - Country:US
Practice Address - Phone:571-635-2761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13349374U00000X
DCRBT-22-223275106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA13349OtherHHA CERTIFICATE NUMBER