Provider Demographics
NPI:1265132690
Name:KADISI, CLEMENCE D
Entity type:Individual
Prefix:
First Name:CLEMENCE
Middle Name:D
Last Name:KADISI
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 1:17125 BERCLAIR TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2520
Mailing Address - Country:US
Mailing Address - Phone:240-310-5181
Mailing Address - Fax:
Practice Address - Street 1:17125 BERCLAIR TER
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2520
Practice Address - Country:US
Practice Address - Phone:240-310-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No376K00000XNursing Service Related ProvidersNurse's Aide