Provider Demographics
NPI:1508750720
Name:TARAWALLIE, KADIATU (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:KADIATU
Middle Name:
Last Name:TARAWALLIE
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 POWDER MILL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2762
Mailing Address - Country:US
Mailing Address - Phone:202-674-0400
Mailing Address - Fax:
Practice Address - Street 1:6841D RIVERDALE RD APT 202D
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-3668
Practice Address - Country:US
Practice Address - Phone:240-521-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200004589374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide