Provider Demographics
NPI:1285025312
Name:HASSAN, FADUMA M
Entity Type:Individual
Prefix:MRS
First Name:FADUMA
Middle Name:M
Last Name:HASSAN
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 1:24808 STONE PILLAR DR
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2954
Mailing Address - Country:US
Mailing Address - Phone:703-946-7139
Mailing Address - Fax:703-738-7955
Practice Address - Street 1:24808 STONE PILLAR DR
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:20105-2954
Practice Address - Country:US
Practice Address - Phone:703-946-7139
Practice Address - Fax:703-738-7955
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO -161242251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health