Individual
KHADIJAT MORENIKE IBUKUN SHODEINDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11200 WAPLES MILL RD UNIT 100, FAIRFAX, VA 22030
(703) 237-2219
Mailing address
3551 CATSKILL ST, WALDORF, MD 20603
(804) 245-1967
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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