Provider Demographics
NPI:1568280568
Name:MEJIA, FANNY CARITO
Entity type:Individual
Prefix:
First Name:FANNY
Middle Name:CARITO
Last Name:MEJIA
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 1:2119 CHAPMAN RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4904
Mailing Address - Country:US
Mailing Address - Phone:240-550-7245
Mailing Address - Fax:
Practice Address - Street 1:18110 CASHELL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-1031
Practice Address - Country:US
Practice Address - Phone:301-706-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant