Provider Demographics
NPI:1932557469
Name:MANYONG, TEMBUH SONITA I
Entity Type:Individual
Prefix:
First Name:TEMBUH
Middle Name:SONITA
Last Name:MANYONG
Suffix:I
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 1:1014 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1014 60TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1420
Practice Address - Country:US
Practice Address - Phone:240-938-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12059374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide