Provider Demographics
NPI:1063249209
Name:MADEY, SUADO ABSHIR
Entity type:Individual
Prefix:
First Name:SUADO
Middle Name:ABSHIR
Last Name:MADEY
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 1:5109 SE 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-3816
Mailing Address - Country:US
Mailing Address - Phone:971-601-8155
Mailing Address - Fax:
Practice Address - Street 1:5109 SE 88TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-3816
Practice Address - Country:US
Practice Address - Phone:971-601-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator