Provider Demographics
NPI:1457044604
Name:LUM, FEDILYNE SUH
Entity Type:Individual
Prefix:
First Name:FEDILYNE
Middle Name:SUH
Last Name:LUM
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 1:7831 RIVERDALE RD APT T3
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4016
Mailing Address - Country:US
Mailing Address - Phone:667-392-3287
Mailing Address - Fax:
Practice Address - Street 1:7831 RIVERDALE RD APT T3
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4016
Practice Address - Country:US
Practice Address - Phone:667-392-3287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200002681374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide