Healthcare Provider Details

I. General information

NPI: 1538083340
Provider Name (Legal Business Name): IBRAHIM FANAH SILLAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6329 KENILWORTH AVE
RIVERDALE MD
20737-1209
US

IV. Provider business mailing address

6329 KENILWORTH AVE
RIVERDALE MD
20737-1209
US

V. Phone/Fax

Practice location:
  • Phone: 301-364-8461
  • Fax:
Mailing address:
  • Phone: 301-364-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: