Provider Demographics
NPI:1225416696
Name:BASHIR, KHADIJAT
Entity Type:Individual
Prefix:
First Name:KHADIJAT
Middle Name:
Last Name:BASHIR
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 1:5648 WHITFIELD CHAPEL RD APT 104
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2562
Mailing Address - Country:US
Mailing Address - Phone:202-706-9686
Mailing Address - Fax:
Practice Address - Street 1:5648 WHITFIELD CHAPEL RD APT 104
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2562
Practice Address - Country:US
Practice Address - Phone:202-706-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11247374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA11247OtherHOME HEALTH AIDE