Provider Demographics
NPI:1417651233
Name:DONFACK, BORIS SR
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:DONFACK
Suffix:SR
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 1:10111 RIGGS RD
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1208
Mailing Address - Country:US
Mailing Address - Phone:281-464-6571
Mailing Address - Fax:
Practice Address - Street 1:10111 RIGGS RD
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1208
Practice Address - Country:US
Practice Address - Phone:281-464-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health