Provider Demographics
NPI:1902315526
Name:ABDULKADIR, KHADIJO IBRAHIM
Entity Type:Individual
Prefix:
First Name:KHADIJO
Middle Name:IBRAHIM
Last Name:ABDULKADIR
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 1:129 MCLENNAN AVE # A
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-1263
Mailing Address - Country:US
Mailing Address - Phone:315-664-5392
Mailing Address - Fax:
Practice Address - Street 1:129 MCLENNAN AVE # A
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-1263
Practice Address - Country:US
Practice Address - Phone:315-664-5392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter