Provider Demographics
NPI:1316404270
Name:ABDILLAHI, MOHAMED M
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:M
Last Name:ABDILLAHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23035 DOUGLAS CT
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2375
Mailing Address - Country:US
Mailing Address - Phone:703-229-8822
Mailing Address - Fax:571-417-7474
Practice Address - Street 1:13824 JEFFERSON PARK DR APT 6203
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4798
Practice Address - Country:US
Practice Address - Phone:571-577-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide