Healthcare Provider Details

I. General information

NPI: 1770094492
Provider Name (Legal Business Name): SEADA HAJIADAM IBRAHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW # 106
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

1131 UNIVERSITY BLVD W
SILVER SPRING MD
20902-3357
US

V. Phone/Fax

Practice location:
  • Phone: 202-506-1209
  • Fax:
Mailing address:
  • Phone: 301-300-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13161
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: