Provider Demographics
NPI:1053184572
Name:YUSHAU, JAMAL O
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:O
Last Name:YUSHAU
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 1:123 WEYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1744
Mailing Address - Country:US
Mailing Address - Phone:202-910-6208
Mailing Address - Fax:
Practice Address - Street 1:123 WEYMOUTH ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1744
Practice Address - Country:US
Practice Address - Phone:202-910-6208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide