Provider Demographics
NPI:1639429269
Name:SHODE, TAWAKALITU AJOKE (CASE MANAGER)
Entity Type:Individual
Prefix:MS
First Name:TAWAKALITU
Middle Name:AJOKE
Last Name:SHODE
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10017 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9270
Mailing Address - Country:US
Mailing Address - Phone:202-701-7807
Mailing Address - Fax:
Practice Address - Street 1:2811 PENNSYLVALVANIA AVENUE SE
Practice Address - Street 2:2811 PENNSYLVALVANIA AVENUE SE
Practice Address - City:BLADENSBURG
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:240-468-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide