Individual
TATA TERRENCE FONYUY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7768 MANDAN RD, GREENBELT, MD 20770-2167
(443) 400-9759
Mailing address
7768 MANDAN RD, GREENBELT, MD 20770-2167
(240) 581-2141
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
MD
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/16/2023
Last updated
12/28/2023
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