Provider Demographics
NPI:1801213533
Name:FABIYI, STELLA
Entity Type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:
Last Name:FABIYI
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 1:5433 16TH AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3419
Mailing Address - Country:US
Mailing Address - Phone:240-764-9131
Mailing Address - Fax:
Practice Address - Street 1:6733 NEW HAMPSHIRE AVE APT 509
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-2847
Practice Address - Country:US
Practice Address - Phone:240-764-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
WAHHA10514251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health