Healthcare Provider Details

I. General information

NPI: 1487123212
Provider Name (Legal Business Name): CYNTHIA UFEI TABOH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2018
Last Update Date: 07/23/2023
Certification Date: 07/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 WARFIELD DR APT 1094
LANDOVER MD
20785-4785
US

IV. Provider business mailing address

410 WARFIELD DR APT 1094
LANDOVER MD
20785-4785
US

V. Phone/Fax

Practice location:
  • Phone: 443-365-4020
  • Fax:
Mailing address:
  • Phone: 443-365-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00175568
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: