Provider Demographics
NPI:1568262954
Name:TANYOUNG, FIDELIS FONYAM
Entity type:Individual
Prefix:
First Name:FIDELIS
Middle Name:FONYAM
Last Name:TANYOUNG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 MCHENRY LN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4159
Mailing Address - Country:US
Mailing Address - Phone:240-280-6709
Mailing Address - Fax:
Practice Address - Street 1:9121 MCHENRY LN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4159
Practice Address - Country:US
Practice Address - Phone:240-280-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator