Provider Demographics
NPI:1255059028
Name:SHIPU, YVONNE PEMWOYA
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:PEMWOYA
Last Name:SHIPU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 GREENBELT RD APT 103
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2229
Mailing Address - Country:US
Mailing Address - Phone:240-579-0908
Mailing Address - Fax:
Practice Address - Street 1:10005 GREENBELT RD APT 103
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2229
Practice Address - Country:US
Practice Address - Phone:240-579-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251S00000X
MDA00191557376K00000X
DCHHA200002154374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No376K00000XNursing Service Related ProvidersNurse's Aide