Provider Demographics
NPI:1003650060
Name:FOMUNYOH, ATUD WILSON
Entity type:Individual
Prefix:
First Name:ATUD
Middle Name:WILSON
Last Name:FOMUNYOH
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 1:10409 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1225
Mailing Address - Country:US
Mailing Address - Phone:240-595-7607
Mailing Address - Fax:
Practice Address - Street 1:10409 FLORAL DR
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1225
Practice Address - Country:US
Practice Address - Phone:240-595-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide