Provider Demographics
NPI:1902681521
Name:SALI, SADISOU
Entity type:Individual
Prefix:
First Name:SADISOU
Middle Name:
Last Name:SALI
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 1:13031 OLD STAGE COACH RD APT 2821
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1645
Mailing Address - Country:US
Mailing Address - Phone:202-823-8964
Mailing Address - Fax:
Practice Address - Street 1:13031 OLD STAGE COACH RD APT 2821
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1645
Practice Address - Country:US
Practice Address - Phone:202-823-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172V00000X172V00000X
DC172V00000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker