Provider Demographics
NPI:1770070864
Name:NYIBECHE, CORNELIUS TIENYI (HHA)
Entity type:Individual
Prefix:MR
First Name:CORNELIUS
Middle Name:TIENYI
Last Name:NYIBECHE
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 ALLOWAY LN
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-6322
Mailing Address - Country:US
Mailing Address - Phone:202-430-8907
Mailing Address - Fax:
Practice Address - Street 1:8013 ALLOWAY LN
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-6322
Practice Address - Country:US
Practice Address - Phone:202-430-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13606374U00000X
DC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD45252919Medicaid
MD3189965-E16-20AOtherSTATEFARM INSURANCE