Provider Demographics
NPI:1043901473
Name:HALL, KHADAIJAH RASHEA (BS)
Entity type:Individual
Prefix:
First Name:KHADAIJAH
Middle Name:RASHEA
Last Name:HALL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 WILLIAMSBRIDGE RD APT 5E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4856
Mailing Address - Country:US
Mailing Address - Phone:929-289-9885
Mailing Address - Fax:
Practice Address - Street 1:2445 WILLIAMSBRIDGE RD APT 5E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4856
Practice Address - Country:US
Practice Address - Phone:929-289-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator