Provider Demographics
NPI:1578369401
Name:AJEITOH, AYONG FABRICE
Entity type:Individual
Prefix:
First Name:AYONG
Middle Name:FABRICE
Last Name:AJEITOH
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 1:1603 KINDLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3835
Mailing Address - Country:US
Mailing Address - Phone:240-736-9235
Mailing Address - Fax:
Practice Address - Street 1:1603 KINDLEWOOD ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-3835
Practice Address - Country:US
Practice Address - Phone:240-736-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide