Individual
KHADIJAH M. SHABAZZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3809 JAY ST NE APT 3, WASHINGTON, DC 20019-1849
(202) 990-9087
Mailing address
2540 ELVANS RD SE APT 303, WASHINGTON, DC 20020-3591
(202) 909-0876
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70089324
—
DC
Enumeration date
05/16/2018
Last updated
05/16/2018
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