Provider Demographics
NPI:1649038183
Name:ACEITUNO SUAZO, MAYCOLA
Entity type:Individual
Prefix:
First Name:MAYCOLA
Middle Name:
Last Name:ACEITUNO SUAZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11508 ELKIN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2856
Mailing Address - Country:US
Mailing Address - Phone:240-596-9630
Mailing Address - Fax:
Practice Address - Street 1:11508 ELKIN ST APT 4
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-2856
Practice Address - Country:US
Practice Address - Phone:240-596-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003525374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide