MEDICARE: ASSATA STARKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518840776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASSATA STARKS

Provider Business Mailing Address
First Line	:	3636 16TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-1146
Country	:	US
Telephone Number	:	816-200-9430
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 4TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20059-1002
Country	:	US
Telephone Number	:	202-806-6870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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Directions to “ ASSATA STARKS ” Practice Location

Language	Start Address	Practice Location

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