Provider Demographics
NPI:1295157089
Name:YIMDO, ESTELLE DORA
Entity type:Individual
Prefix:
First Name:ESTELLE DORA
Middle Name:
Last Name:YIMDO
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 1:20334 BEACONFIELD TER APT 102
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3915
Mailing Address - Country:US
Mailing Address - Phone:202-751-6519
Mailing Address - Fax:
Practice Address - Street 1:11140 ROCKVILLE PIKE STE 100-807
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3106
Practice Address - Country:US
Practice Address - Phone:202-751-6519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385HR2050X, 106S00000X, 247200000X
DCHHA10146374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No374U00000XNursing Service Related ProvidersHome Health Aide
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other