Provider Demographics
NPI:1689365934
Name:NKEMTAJI, RANDY TAYE
Entity type:Individual
Prefix:
First Name:RANDY TAYE
Middle Name:
Last Name:NKEMTAJI
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 1:6708 W FOREST RD APT 301
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3316
Mailing Address - Country:US
Mailing Address - Phone:571-895-9286
Mailing Address - Fax:
Practice Address - Street 1:6708 W FOREST RD APT 301
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-3316
Practice Address - Country:US
Practice Address - Phone:571-895-9286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide