MEDICARE: FIDELIS E EBAKO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1043577620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIDELIS E EBAKO

Provider Business Mailing Address
First Line	:	2709 NICHOLSON ST
Second Line	:	APT#203
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-2811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 NICHOLSON ST
Second Line	:	APT#203
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-2811
Country	:	US
Telephone Number	:	202-722-1725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	05/27/2025

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Directions to “ FIDELIS E EBAKO ” Practice Location

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