Healthcare Provider Details

I. General information

NPI: 1073341954
Provider Name (Legal Business Name): SHAMARA KADIJATU FOFANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH ST NE
WASHINGTON DC
20018-2126
US

IV. Provider business mailing address

14132 WHISPERING PINES CT APT 32
SILVER SPRING MD
20906-2435
US

V. Phone/Fax

Practice location:
  • Phone: 408-348-5255
  • Fax:
Mailing address:
  • Phone: 240-579-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200004478
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: