Provider Demographics
NPI:1023341278
Name:WALDRON, KHADIJAH (MS ED)
Entity type:Individual
Prefix:MS
First Name:KHADIJAH
Middle Name:
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 METROPOLITAN AVE APT 5G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6116
Mailing Address - Country:US
Mailing Address - Phone:917-418-2936
Mailing Address - Fax:
Practice Address - Street 1:1527 METROPOLITAN AVE APT 5G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6116
Practice Address - Country:US
Practice Address - Phone:917-418-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist