Provider Demographics
NPI:1982117735
Name:AZAH, ADELINE KYENG
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:KYENG
Last Name:AZAH
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 1:2419 LYTTONSVILLE RD APT 304
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1928
Mailing Address - Country:US
Mailing Address - Phone:240-413-5734
Mailing Address - Fax:
Practice Address - Street 1:2419 LYTTONSVILLE RD APT 304
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1928
Practice Address - Country:US
Practice Address - Phone:240-413-5734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator