Provider Demographics
NPI:1093341752
Name:GODANA, KASECH ABEDCHO
Entity Type:Individual
Prefix:
First Name:KASECH
Middle Name:ABEDCHO
Last Name:GODANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 ASTORIA CIR APT 105
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-6117
Mailing Address - Country:US
Mailing Address - Phone:571-635-3997
Mailing Address - Fax:
Practice Address - Street 1:2231 ASTORIA CIR APT 105
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-6117
Practice Address - Country:US
Practice Address - Phone:571-635-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant