Provider Demographics
NPI:1861115214
Name:JANNEH, SAFFIATU
Entity type:Individual
Prefix:
First Name:SAFFIATU
Middle Name:
Last Name:JANNEH
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 1:25 WINDING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-3912
Mailing Address - Country:US
Mailing Address - Phone:571-277-5259
Mailing Address - Fax:
Practice Address - Street 1:18091 COOLIDGE LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-9340
Practice Address - Country:US
Practice Address - Phone:540-919-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3510251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health