Provider Demographics
NPI:1831450741
Name:MALIYATABU, AMRI NGOYE
Entity type:Individual
Prefix:
First Name:AMRI
Middle Name:NGOYE
Last Name:MALIYATABU
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 1:9401 MATHY DR STE 350
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5333
Mailing Address - Country:US
Mailing Address - Phone:240-426-8271
Mailing Address - Fax:
Practice Address - Street 1:9401 MATHY DRIVE SUITE 350
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:240-426-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker