Healthcare Provider Details

I. General information

NPI: 1801213533
Provider Name (Legal Business Name): MRS. STELLA FABIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6733 NEW HAMPSHIRE AVE APT 509
TAKOMA PARK MD
20912-2847
US

IV. Provider business mailing address

5433 16TH AVE APT 104
HYATTSVILLE MD
20782-3419
US

V. Phone/Fax

Practice location:
  • Phone: 240-764-9131
  • Fax:
Mailing address:
  • Phone: 240-764-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA10514
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: