Provider Demographics
NPI:1952142101
Name:TADESSE, ABEBAYEHU TESHOME (CERTIFICATE)
Entity type:Individual
Prefix:
First Name:ABEBAYEHU
Middle Name:TESHOME
Last Name:TADESSE
Suffix:
Gender:F
Credentials:CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 MAPLE AVE APT 1403
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5556
Mailing Address - Country:US
Mailing Address - Phone:240-595-8206
Mailing Address - Fax:
Practice Address - Street 1:7600 MAPLE AVE APT 1403
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5556
Practice Address - Country:US
Practice Address - Phone:240-595-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003770374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide