Healthcare Provider Details

I. General information

NPI: 1033048830
Provider Name (Legal Business Name): KADIJATOU BARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N UNION ST STE 100
ALEXANDRIA VA
22314-2643
US

IV. Provider business mailing address

6901 PROFESSIONAL PKWY STE 200
LAKEWOOD RANCH FL
34240-8473
US

V. Phone/Fax

Practice location:
  • Phone: 888-720-2095
  • Fax: 813-723-1260
Mailing address:
  • Phone: 888-720-2095
  • Fax: 813-723-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: