Provider Demographics
NPI:1982312195
Name:MADESSA, MALEFIYA KENEA (FNP)
Entity Type:Individual
Prefix:
First Name:MALEFIYA
Middle Name:KENEA
Last Name:MADESSA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 CHAPEL CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1978
Mailing Address - Country:US
Mailing Address - Phone:917-703-6786
Mailing Address - Fax:
Practice Address - Street 1:5140 NANNIE HELEN BURROUGHS AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5509
Practice Address - Country:US
Practice Address - Phone:917-703-6786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1056220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily