Provider Demographics
NPI:1861949166
Name:YESHANEW, MAHEDER WUBU
Entity type:Individual
Prefix:
First Name:MAHEDER
Middle Name:WUBU
Last Name:YESHANEW
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 1:8421 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-3026
Mailing Address - Country:US
Mailing Address - Phone:240-353-5830
Mailing Address - Fax:
Practice Address - Street 1:8421 10TH AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3026
Practice Address - Country:US
Practice Address - Phone:240-353-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12031374U00000X
DCNA00607707376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide