Provider Demographics
NPI:1154017341
Name:MUSTEFA, SALIYA WABELA (N/A)
Entity type:Individual
Prefix:
First Name:SALIYA
Middle Name:WABELA
Last Name:MUSTEFA
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14419 ASTRODOME DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2247
Mailing Address - Country:US
Mailing Address - Phone:571-317-8749
Mailing Address - Fax:
Practice Address - Street 1:14419 ASTRODOME DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2247
Practice Address - Country:US
Practice Address - Phone:571-317-8749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide