MEDICARE: MATOU CISSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HHA200001797	DC

General Provider Information

NPI Number	:	1417602657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATOU CISSE

Provider Business Mailing Address
First Line	:	9871 GOOD LUCK RD APT 5
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3229
Country	:	US
Telephone Number	:	240-714-1105
Fax Number	:

Provider Business Practice Location Address
First Line	:	9871 GOOD LUCK RD APT 5
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3229
Country	:	US
Telephone Number	:	240-714-1105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	03/02/2026

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Directions to “ MATOU CISSE ” Practice Location

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