Provider Demographics
NPI:1104508639
Name:WAHAB, ABIDEMI M
Entity type:Individual
Prefix:
First Name:ABIDEMI
Middle Name:M
Last Name:WAHAB
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 1:7918 DUNHILL VILLAGE CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-4119
Mailing Address - Country:US
Mailing Address - Phone:347-327-7278
Mailing Address - Fax:
Practice Address - Street 1:7918 DUNHILL VILLAGE CIR APT 304
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-4119
Practice Address - Country:US
Practice Address - Phone:347-327-7278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-01688374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide