Provider Demographics
NPI:1295094860
Name:AGYEMANE, CHERYL D
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
Last Name:AGYEMANE
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 1:1107GLEN WILLOW DR APT 2
Mailing Address - Street 2:
Mailing Address - City:SEAT PLEASANT
Mailing Address - State:MD
Mailing Address - Zip Code:20743
Mailing Address - Country:US
Mailing Address - Phone:202-702-5358
Mailing Address - Fax:
Practice Address - Street 1:1107 GLEN WILLOW DR APT 2
Practice Address - Street 2:
Practice Address - City:SEAT PLEASANT
Practice Address - State:MD
Practice Address - Zip Code:20743-1564
Practice Address - Country:US
Practice Address - Phone:202-702-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA255115139126374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide