Provider Demographics
NPI:1679395263
Name:UMEAYUGHO, LUSCIENE NDIFOR
Entity type:Individual
Prefix:
First Name:LUSCIENE
Middle Name:NDIFOR
Last Name:UMEAYUGHO
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 1:9435 FAIRHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5363
Mailing Address - Country:US
Mailing Address - Phone:202-527-5470
Mailing Address - Fax:
Practice Address - Street 1:9435 FAIRHAVEN AVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-5363
Practice Address - Country:US
Practice Address - Phone:202-527-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X
DCHHA200004384374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker