Provider Demographics
NPI:1295048338
Name:CADEAU, TAFFAE MAYONETTE (NP)
Entity type:Individual
Prefix:
First Name:TAFFAE
Middle Name:MAYONETTE
Last Name:CADEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 GREENVIEW LN STE 101
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3217
Mailing Address - Country:US
Mailing Address - Phone:540-439-9000
Mailing Address - Fax:540-439-9099
Practice Address - Street 1:201 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REMINGTON
Practice Address - State:VA
Practice Address - Zip Code:22734-9693
Practice Address - Country:US
Practice Address - Phone:540-439-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195009363LF0000X
DC1026045363LF0000X
VA0024169133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295048338Medicaid