Provider Demographics
NPI:1255135125
Name:WONDUMO, MEHDI FANTA
Entity type:Individual
Prefix:MS
First Name:MEHDI
Middle Name:FANTA
Last Name:WONDUMO
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 1:8830 PINEY BRANCH RD APT 712
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-3510
Mailing Address - Country:US
Mailing Address - Phone:240-479-5858
Mailing Address - Fax:
Practice Address - Street 1:8830 PINEY BRANCH RD APT 712
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3510
Practice Address - Country:US
Practice Address - Phone:240-479-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200004763374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide