Provider Demographics
NPI:1346712353
Name:JANNEH, FODAY
Entity Type:Individual
Prefix:
First Name:FODAY
Middle Name:
Last Name:JANNEH
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:PO BOX 2762
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01613-2762
Mailing Address - Country:US
Mailing Address - Phone:860-788-6404
Mailing Address - Fax:877-794-3529
Practice Address - Street 1:600 N 2ND ST STE 401
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1071
Practice Address - Country:US
Practice Address - Phone:860-788-6404
Practice Address - Fax:877-794-3529
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028389363LP0808X
PASP019800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP019800OtherLICENSE