Provider Demographics
NPI:1043190556
Name:GEBREHIWOT, AYALENSH TESERA
Entity type:Individual
Prefix:
First Name:AYALENSH
Middle Name:TESERA
Last Name:GEBREHIWOT
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 1:6060 TOWER CT APT 803
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3223
Mailing Address - Country:US
Mailing Address - Phone:703-801-0009
Mailing Address - Fax:
Practice Address - Street 1:6060 TOWER CT APT 803
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3223
Practice Address - Country:US
Practice Address - Phone:703-801-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty