Provider Demographics
NPI:1477173169
Name:KAIMACHIANDE, SIA BINTU
Entity Type:Individual
Prefix:
First Name:SIA
Middle Name:BINTU
Last Name:KAIMACHIANDE
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 1:6019 67TH AVE 5
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:DC
Mailing Address - Zip Code:29737
Mailing Address - Country:US
Mailing Address - Phone:240-696-9410
Mailing Address - Fax:
Practice Address - Street 1:4200 S CAPITOL ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1342
Practice Address - Country:US
Practice Address - Phone:443-882-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA001454803747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant