Provider Demographics
NPI:1538540166
Name:MALEFIA, YEWUNETU DESSALEGN
Entity type:Individual
Prefix:
First Name:YEWUNETU
Middle Name:DESSALEGN
Last Name:MALEFIA
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 1:1909 MERRIMAC DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2243
Mailing Address - Country:US
Mailing Address - Phone:240-645-6085
Mailing Address - Fax:
Practice Address - Street 1:1909 MERRIMAC DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-2243
Practice Address - Country:US
Practice Address - Phone:240-645-6085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10811374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide