Healthcare Provider Details

I. General information

NPI: 1417897679
Provider Name (Legal Business Name): KADIATOU SAM KAMARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 FONTANA DR
LANHAM MD
20706-2465
US

IV. Provider business mailing address

9320 FONTANA DR
LANHAM MD
20706-2465
US

V. Phone/Fax

Practice location:
  • Phone: 202-681-2311
  • Fax:
Mailing address:
  • Phone: 202-681-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006211
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: