Provider Demographics
NPI:1679699656
Name:MUKATI, ABDUL SAMAD (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:SAMAD
Last Name:MUKATI
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E FAIRFAX ST APT 224
Mailing Address - Street 2:# 224
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-2907
Mailing Address - Country:US
Mailing Address - Phone:703-225-8065
Mailing Address - Fax:
Practice Address - Street 1:7124 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2309
Practice Address - Country:US
Practice Address - Phone:703-248-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist