Provider Demographics
NPI:1316746266
Name:JEJE, TAIBAT T
Entity type:Individual
Prefix:MRS
First Name:TAIBAT
Middle Name:T
Last Name:JEJE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 LIGHTHOUSE WAY APT 33
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3416
Mailing Address - Country:US
Mailing Address - Phone:202-977-6466
Mailing Address - Fax:
Practice Address - Street 1:3804 LIGHTHOUSE WAY
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3416
Practice Address - Country:US
Practice Address - Phone:202-977-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator