Provider Demographics
NPI:1649975624
Name:ABREFA-KODOM, CYNTHIA AFIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:AFIA
Last Name:ABREFA-KODOM
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 1:902 BUKER CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-3040
Mailing Address - Country:US
Mailing Address - Phone:215-520-7319
Mailing Address - Fax:
Practice Address - Street 1:810 NEW BURTON RD STE 3
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-5488
Practice Address - Country:US
Practice Address - Phone:302-730-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily