Provider Demographics
NPI:1801516539
Name:DOMOND, NINJA KING (HHA)
Entity type:Individual
Prefix:
First Name:NINJA
Middle Name:KING
Last Name:DOMOND
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAURA LN APT 202
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-1254
Mailing Address - Country:US
Mailing Address - Phone:215-452-3966
Mailing Address - Fax:302-875-2601
Practice Address - Street 1:300 LAURA LN APT 202
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1254
Practice Address - Country:US
Practice Address - Phone:215-452-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE10000520445251E00000X, 374U00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide