Provider Demographics
NPI:1679252431
Name:NGOME, NADESH MUNGE
Entity type:Individual
Prefix:
First Name:NADESH
Middle Name:MUNGE
Last Name:NGOME
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 1:9933 GOOD LUCK RD APT T4
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3260
Mailing Address - Country:US
Mailing Address - Phone:240-784-9328
Mailing Address - Fax:
Practice Address - Street 1:9933 GOOD LUCK RD APT T4
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3260
Practice Address - Country:US
Practice Address - Phone:240-784-9328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251S00000XAgenciesCommunity/Behavioral Health