Provider Demographics
NPI:1104168947
Name:MADUBUKO, STELLA
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:MADUBUKO
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 1:8113 BIRD LN
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2104
Mailing Address - Country:US
Mailing Address - Phone:240-535-8314
Mailing Address - Fax:
Practice Address - Street 1:7603 GEORGIA AVE NW STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1617
Practice Address - Country:US
Practice Address - Phone:202-545-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator