Provider Demographics
NPI:1811533466
Name:BENDU, KHADIJA
Entity type:Individual
Prefix:MRS
First Name:KHADIJA
Middle Name:
Last Name:BENDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SINNAH
Other - Middle Name:
Other - Last Name:MOMOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 YOSEMITE RDG
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7765
Mailing Address - Country:US
Mailing Address - Phone:571-315-0198
Mailing Address - Fax:
Practice Address - Street 1:4 YOSEMITE RDG
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7765
Practice Address - Country:US
Practice Address - Phone:571-315-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001214310163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse