Provider Demographics
NPI:1669120929
Name:EFUETCHA, ACHAFAC STANLEY
Entity type:Individual
Prefix:
First Name:ACHAFAC
Middle Name:STANLEY
Last Name:EFUETCHA
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 1:3400 DODGE PARK RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2001
Mailing Address - Country:US
Mailing Address - Phone:301-454-9167
Mailing Address - Fax:
Practice Address - Street 1:3400 DODGE PARK RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2001
Practice Address - Country:US
Practice Address - Phone:301-454-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide