Provider Demographics
NPI:1396242160
Name:MOCHE TETSO, SIDONIE
Entity type:Individual
Prefix:
First Name:SIDONIE
Middle Name:
Last Name:MOCHE TETSO
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 1:7779 RIVERDALE RD APT 303
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3939
Mailing Address - Country:US
Mailing Address - Phone:240-533-6100
Mailing Address - Fax:
Practice Address - Street 1:7779 RIVERDALE RD APT 303
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3939
Practice Address - Country:US
Practice Address - Phone:240-533-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13504374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide