Provider Demographics
NPI:1205513363
Name:FAUNTROY, TONYA R
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:R
Last Name:FAUNTROY
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 1:2657 STANTON RD SE APT 208
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4464
Mailing Address - Country:US
Mailing Address - Phone:202-905-5314
Mailing Address - Fax:
Practice Address - Street 1:1850 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2810
Practice Address - Country:US
Practice Address - Phone:202-678-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant