Provider Demographics
NPI:1811670946
Name:AWANDAM, SIBORA BIH
Entity type:Individual
Prefix:
First Name:SIBORA
Middle Name:BIH
Last Name:AWANDAM
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 1:3327 TEAGARDEN CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7528
Mailing Address - Country:US
Mailing Address - Phone:240-277-3431
Mailing Address - Fax:
Practice Address - Street 1:3327 TEAGARDEN CIR APT 202
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7528
Practice Address - Country:US
Practice Address - Phone:240-277-3431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN500011421163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health