Individual
THEODORE BENYELLA FOMUNYAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2918 MINNESOTA AVE SE, WASHINGTON, DC 20019-1127
(202) 839-5310
(202) 810-9189
Mailing address
10419 STONE PINE AVE, WALDORF, MD 20603-5797
(301) 851-1176
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/19/2025
Last updated
04/07/2025
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