Provider Demographics
NPI:1922817410
Name:SESAY, MABEL QUEEN
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:QUEEN
Last Name:SESAY
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 1:16801 CAPON TREE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5134
Mailing Address - Country:US
Mailing Address - Phone:703-865-9191
Mailing Address - Fax:
Practice Address - Street 1:16801 CAPON TREE LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5134
Practice Address - Country:US
Practice Address - Phone:703-865-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide