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General NPI Number Information
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NPI Number | 1831763218
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Entity Type | Individual
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Provider Name | BINTA I FONYONGA
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Gender | Female
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 6495 NEW HAMPSHIRE AVE STE A303
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City | HYATTSVILLE
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State | MD
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Zip | 20783-3245
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Country | US
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Telephone | 240-825-3153
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Fax |
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Provider Business Mailing Address
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Address Line | 11337 DRUMSHEUGH LN
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-5749
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Country | US
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Telephone | 301-675-3847
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | A00185588
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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