Provider Demographics
NPI:1144852484
Name:SWEENEY, NIJAE
Entity type:Individual
Prefix:
First Name:NIJAE
Middle Name:
Last Name:SWEENEY
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 1:612 ELMIRA ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3536
Mailing Address - Country:US
Mailing Address - Phone:240-830-0573
Mailing Address - Fax:
Practice Address - Street 1:4361 BENNING RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4554
Practice Address - Country:US
Practice Address - Phone:202-594-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health