Provider Demographics
NPI:1902356165
Name:TANYI, AYUKMANYI
Entity Type:Individual
Prefix:
First Name:AYUKMANYI
Middle Name:
Last Name:TANYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9751 GOOD LUCK RD
Mailing Address - Street 2:APT. #6
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3349
Mailing Address - Country:US
Mailing Address - Phone:240-714-0897
Mailing Address - Fax:
Practice Address - Street 1:9751 GOOD LUCK RD
Practice Address - Street 2:APT. #6
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3349
Practice Address - Country:US
Practice Address - Phone:240-714-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12436374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA12436OtherHOME HEALTH AIDE CERTIFICATE