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General NPI Number Information
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NPI Number | 1558839506
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Entity Type | Individual
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Provider Name | MR. SUNDAY ADEDAMOLA FATANMI
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Gender | Male
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 9127 OLD GEORGETOWN RD
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City | BETHESDA
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State | MD
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Zip | 20814-1616
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Country | US
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Telephone | 301-897-0780
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Fax |
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Provider Business Mailing Address
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Address Line | 7604 GREEN WILLOW CT
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City | HYATTSVILLE
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State | MD
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Zip | 20785-4671
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Country | US
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Telephone | 240-615-6257
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | NA0000807846
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License Number State | DC
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