Provider Demographics
NPI:1649846999
Name:FILLIE-FABOE, FYNDA
Entity type:Individual
Prefix:MS
First Name:FYNDA
Middle Name:
Last Name:FILLIE-FABOE
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 1:18625 HEDGEGROVE TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1812
Mailing Address - Country:US
Mailing Address - Phone:202-352-0086
Mailing Address - Fax:
Practice Address - Street 1:3508 WORTHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7032
Practice Address - Country:US
Practice Address - Phone:301-330-0006
Practice Address - Fax:301-330-0444
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR116752363LP0808X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health