Healthcare Provider Details

I. General information

NPI: 1073392031
Provider Name (Legal Business Name): KADIJATU SESAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42979 GOLF VIEW DR
CHANTILLY VA
20152-2006
US

IV. Provider business mailing address

42979 GOLF VIEW DR
CHANTILLY VA
20152-2006
US

V. Phone/Fax

Practice location:
  • Phone: 614-596-3596
  • Fax:
Mailing address:
  • Phone: 614-596-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024188100
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: