Provider Demographics
NPI:1902573850
Name:TUFUOR, FIDELIA YAA
Entity type:Individual
Prefix:
First Name:FIDELIA
Middle Name:YAA
Last Name:TUFUOR
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 1:9522 PIAFFE CIR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4681
Mailing Address - Country:US
Mailing Address - Phone:240-274-4794
Mailing Address - Fax:
Practice Address - Street 1:9522 PIAFFE CIR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4681
Practice Address - Country:US
Practice Address - Phone:240-274-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL1264310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility