Provider Demographics
NPI:1174320360
Name:NGWA AFANWI, DADDY BRIAN
Entity type:Individual
Prefix:
First Name:DADDY BRIAN
Middle Name:
Last Name:NGWA AFANWI
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 1:15378 BALD EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3739
Mailing Address - Country:US
Mailing Address - Phone:571-602-1888
Mailing Address - Fax:
Practice Address - Street 1:4565 DAISY REID AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5670
Practice Address - Country:US
Practice Address - Phone:571-602-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based