Provider Demographics
NPI:1558839506
Name:FATANMI, SUNDAY ADEDAMOLA
Entity Type:Individual
Prefix:MR
First Name:SUNDAY
Middle Name:ADEDAMOLA
Last Name:FATANMI
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 1:7604 GREEN WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4671
Mailing Address - Country:US
Mailing Address - Phone:240-615-6257
Mailing Address - Fax:
Practice Address - Street 1:9127 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1616
Practice Address - Country:US
Practice Address - Phone:301-897-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000807846376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide