Provider Demographics
NPI:1366255531
Name:TEFERA, ADONAY EYESUS
Entity type:Individual
Prefix:
First Name:ADONAY
Middle Name:EYESUS
Last Name:TEFERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ADONAY
Other - Middle Name:EYESUS
Other - Last Name:SEFANIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:640 FREEDOM BUSINESS CTR DR STE 220
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4701 RANDOLPH RD STE G5
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2259
Practice Address - Country:US
Practice Address - Phone:484-965-9966
Practice Address - Fax:484-231-8631
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician