Provider Demographics
NPI:1467255844
Name:BANINJOYO, ROSELINE
Entity type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:BANINJOYO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 LAMONT DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4606
Mailing Address - Country:US
Mailing Address - Phone:223-307-9477
Mailing Address - Fax:
Practice Address - Street 1:6933 LAMONT DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4606
Practice Address - Country:US
Practice Address - Phone:223-307-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide