Provider Demographics
NPI:1477334217
Name:CHEUJI FOGTA, VANESSA DORA
Entity Type:Individual
Prefix:
First Name:VANESSA DORA
Middle Name:
Last Name:CHEUJI FOGTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 ANNAPOLIS RD APT 301
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2010
Mailing Address - Country:US
Mailing Address - Phone:240-486-1435
Mailing Address - Fax:
Practice Address - Street 1:5804 ANNAPOLIS RD APT 301
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2010
Practice Address - Country:US
Practice Address - Phone:240-486-1435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide