Provider Demographics
NPI:1982484051
Name:WOLDEAMANUEL, ELLENI ABAYNEH
Entity Type:Individual
Prefix:
First Name:ELLENI
Middle Name:ABAYNEH
Last Name:WOLDEAMANUEL
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 1:8201 CORPORATE DR STE 630
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2371
Mailing Address - Country:US
Mailing Address - Phone:240-426-3859
Mailing Address - Fax:
Practice Address - Street 1:8201 CORPORATE DR STE 630
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2371
Practice Address - Country:US
Practice Address - Phone:240-426-3859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC005921363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health