Provider Demographics
NPI:1306625678
Name:FIDELIS, PENN ANONCHU
Entity type:Individual
Prefix:
First Name:PENN ANONCHU
Middle Name:
Last Name:FIDELIS
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 1:3208 TOLEDO PL
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4120
Mailing Address - Country:US
Mailing Address - Phone:240-926-7404
Mailing Address - Fax:
Practice Address - Street 1:3208 TOLEDO PL
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4120
Practice Address - Country:US
Practice Address - Phone:240-926-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide