Provider Demographics
NPI:1073947297
Name:EPAH, SEBASTIAN FOMANKA
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:FOMANKA
Last Name:EPAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8606 FLOWER AVE
Mailing Address - Street 2:# 302
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6630
Mailing Address - Country:US
Mailing Address - Phone:240-701-0284
Mailing Address - Fax:
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE
Practice Address - Street 2:STE 504F
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3269
Practice Address - Country:US
Practice Address - Phone:301-560-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide