Healthcare Provider Details

I. General information

NPI: 1457610313
Provider Name (Legal Business Name): FOLASADE FAMAKINWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE 228
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

1818 NEW YORK AVE NE 228
WASHINGTON DC
20002-1848
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax:
Mailing address:
  • Phone: 202-832-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA2073
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: