Healthcare Provider Details

I. General information

NPI: 1528679941
Provider Name (Legal Business Name): SIDNEY MADUFORO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 GOOD LUCK RD
LANHAM MD
20706-3511
US

IV. Provider business mailing address

1664 MIDNIGHT SUN DR
BEAUMONT CA
92223-8443
US

V. Phone/Fax

Practice location:
  • Phone: 301-623-4352
  • Fax: 301-623-4351
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: