Provider Demographics
NPI:1144709908
Name:SAFFA, ISATU SIA
Entity type:Individual
Prefix:MS
First Name:ISATU
Middle Name:SIA
Last Name:SAFFA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ASIATU
Other - Middle Name:SIA
Other - Last Name:BAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12106 WESTLOCK PL
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2422
Mailing Address - Country:US
Mailing Address - Phone:240-713-0699
Mailing Address - Fax:
Practice Address - Street 1:9870A MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3908
Practice Address - Country:US
Practice Address - Phone:571-317-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00144644106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician