Provider Demographics
NPI:1750923116
Name:AKANDE, SIMON NKWELLE
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:NKWELLE
Last Name:AKANDE
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 1:6701 W FOREST RD APT 202
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3308
Mailing Address - Country:US
Mailing Address - Phone:240-906-7906
Mailing Address - Fax:
Practice Address - Street 1:5513 ILLINOIS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2937
Practice Address - Country:US
Practice Address - Phone:202-882-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14692374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide