Provider Demographics
NPI:1265191019
Name:ACHALEKE, KELLY AGENDIA
Entity type:Individual
Prefix:
First Name:KELLY AGENDIA
Middle Name:
Last Name:ACHALEKE
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 1:9751 GOOD LUCK RD APT 8
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3349
Mailing Address - Country:US
Mailing Address - Phone:240-729-9589
Mailing Address - Fax:
Practice Address - Street 1:9751 GOOD LUCK RD APT 8
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3349
Practice Address - Country:US
Practice Address - Phone:240-729-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide