Provider Demographics
NPI:1770314718
Name:JALLOH, KHADIJA BAMBAY
Entity type:Individual
Prefix:
First Name:KHADIJA
Middle Name:BAMBAY
Last Name:JALLOH
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 1:10102 GAYLEWINDS CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3169
Mailing Address - Country:US
Mailing Address - Phone:240-486-7038
Mailing Address - Fax:
Practice Address - Street 1:10102 GAYLEWINDS CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3169
Practice Address - Country:US
Practice Address - Phone:240-486-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker