Healthcare Provider Details

I. General information

NPI: 1427605864
Provider Name (Legal Business Name): ALIYAH KHALIFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14409 GREENVIEW DR STE 102
LAUREL MD
20708-4213
US

IV. Provider business mailing address

PO BOX 500
BROOKEVILLE MD
20833-0500
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-8100
  • Fax:
Mailing address:
  • Phone: 301-498-8100
  • Fax: 301-498-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number00128L
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: