MEDICARE: SULAKHA MOHAMED ABDI RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	251E00000X	Home Health Agency	HCO-0005728	VA

General Provider Information

NPI Number	:	1780419788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SULAKHA MOHAMED ABDI RN

Provider Business Mailing Address
First Line	:	5622 COLUMBIA PIKE STE 307B
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2718
Country	:	US
Telephone Number	:	571-331-6328
Fax Number	:	571-347-7177

Provider Business Practice Location Address
First Line	:	5622 COLUMBIA PIKE STE 307B
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2718
Country	:	US
Telephone Number	:	571-331-6328
Fax Number	:	571-347-7177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	03/27/2025

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