Provider Demographics
NPI:1396556130
Name:KAMAAL, AYAMODINE
Entity type:Individual
Prefix:
First Name:AYAMODINE
Middle Name:
Last Name:KAMAAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16690 BLACKJACK OAK LN UNIT 403
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4662
Mailing Address - Country:US
Mailing Address - Phone:202-924-8828
Mailing Address - Fax:
Practice Address - Street 1:16690 BLACKJACK OAK LN UNIT 403
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4662
Practice Address - Country:US
Practice Address - Phone:202-924-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist