Provider Demographics
NPI:1457917445
Name:SADJO, RACHELE KAMWA
Entity Type:Individual
Prefix:
First Name:RACHELE
Middle Name:KAMWA
Last Name:SADJO
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 1:2129 ROLANDER ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2158
Mailing Address - Country:US
Mailing Address - Phone:202-779-7098
Mailing Address - Fax:
Practice Address - Street 1:2129 ROLANDER ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-2158
Practice Address - Country:US
Practice Address - Phone:202-779-7098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide