Provider Demographics
NPI:1205473683
Name:EDEIFO, GIFT (CSW)
Entity type:Individual
Prefix:
First Name:GIFT
Middle Name:
Last Name:EDEIFO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4863
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20775-0863
Mailing Address - Country:US
Mailing Address - Phone:240-467-4649
Mailing Address - Fax:
Practice Address - Street 1:810 BLEAK HILL PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8870
Practice Address - Country:US
Practice Address - Phone:240-467-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 171M00000X
MDMT0129579374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No374700000XNursing Service Related ProvidersTechnician