Provider Demographics
NPI:1710688759
Name:DJIDOTOR, ABLA SENAME
Entity Type:Individual
Prefix:
First Name:ABLA
Middle Name:SENAME
Last Name:DJIDOTOR
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 1:6319 LANDOVER RD APT 103
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1320
Mailing Address - Country:US
Mailing Address - Phone:240-825-7794
Mailing Address - Fax:
Practice Address - Street 1:6319 LANDOVER RD APT 103
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1320
Practice Address - Country:US
Practice Address - Phone:240-825-7794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide