Provider Demographics
NPI:1891508644
Name:FOZAO AZENDEM, ASHUNGAFACK FRANK
Entity type:Individual
Prefix:
First Name:ASHUNGAFACK
Middle Name:FRANK
Last Name:FOZAO AZENDEM
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 1:3982 WARNER AVE APT A1
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2001
Mailing Address - Country:US
Mailing Address - Phone:240-960-9866
Mailing Address - Fax:
Practice Address - Street 1:3982 WARNER AVE APT A1
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-2001
Practice Address - Country:US
Practice Address - Phone:240-960-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171M00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator