Provider Demographics
NPI:1396434742
Name:JOKO EPSE FONGYEN, MIRANDA SHINDOH
Entity type:Individual
Prefix:
First Name:MIRANDA SHINDOH
Middle Name:
Last Name:JOKO EPSE FONGYEN
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 1:16707 GOVERNOR BRIDGE RD APT 301
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3699
Mailing Address - Country:US
Mailing Address - Phone:202-937-7814
Mailing Address - Fax:
Practice Address - Street 1:16707 GOVERNOR BRIDGE RD APT 301
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3699
Practice Address - Country:US
Practice Address - Phone:202-937-7814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide