Provider Demographics
NPI:1942554639
Name:RUDYKOFF, ELLEN
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:RUDYKOFF
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 1:8757 GEORGIA AVE STE 805
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3708
Mailing Address - Country:US
Mailing Address - Phone:240-737-5163
Mailing Address - Fax:240-737-5154
Practice Address - Street 1:8757 GEORGIA AVE STE 805
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3708
Practice Address - Country:US
Practice Address - Phone:240-737-5163
Practice Address - Fax:240-737-5154
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1588171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator