Healthcare Provider Details

I. General information

NPI: 1962382101
Provider Name (Legal Business Name): KASSIM HAIREDIN MOHAMMED REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 NANNIE HELEN BURROUGHS AVE NE # A
WASHINGTON DC
20019-5506
US

IV. Provider business mailing address

3622 MAVEN ST # A
SILVER SPRING MD
20906-1148
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-7504
  • Fax:
Mailing address:
  • Phone: 202-399-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1022083
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: