Healthcare Provider Details

I. General information

NPI: 1073382529
Provider Name (Legal Business Name): KOFFI YEYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 NICHOLSON ST
HYATTSVILLE MD
20782-2674
US

IV. Provider business mailing address

2627 NICHOLSON ST
HYATTSVILLE MD
20782-2674
US

V. Phone/Fax

Practice location:
  • Phone: 240-784-3404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: