Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | RT005186 | PA |
NPI | 1285161604 |
---|---|
Provider Name | Miss Fafa Tsikata |
First Address | Lewisburg, PA 17837-1507 |
Second Address | Yeadon, PA 19050-3114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2017 |
Last Update Date | 16/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200005221 | BOARD OF CERTIFICATION (01) | |
RT005186 | PENNSYLVANIA BOARD OF MEDICINE (01) | PA |