Provider Demographics
NPI:1518400928
Name:RELIEDISSE, FUETCHAH
Entity Type:Individual
Prefix:
First Name:FUETCHAH
Middle Name:
Last Name:RELIEDISSE
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 1:7309 SUNRISE CT
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2470
Mailing Address - Country:US
Mailing Address - Phone:240-360-9921
Mailing Address - Fax:
Practice Address - Street 1:7309 SUNRISE CT
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2470
Practice Address - Country:US
Practice Address - Phone:240-360-9921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator