Provider Demographics
NPI:1760278857
Name:FOTCHAM, STELLA ANYA
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:ANYA
Last Name:FOTCHAM
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 1:5227 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-2851
Mailing Address - Country:US
Mailing Address - Phone:202-381-8109
Mailing Address - Fax:
Practice Address - Street 1:5227 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-2851
Practice Address - Country:US
Practice Address - Phone:202-381-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide