Healthcare Provider Details

I. General information

NPI: 1104780121
Provider Name (Legal Business Name): DEESHA AMELIA PENNYFATHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E ST SE
WASHINGTON DC
20003-2593
US

IV. Provider business mailing address

723 FALLSGROVE DR APT 4133
ROCKVILLE MD
20850-8713
US

V. Phone/Fax

Practice location:
  • Phone: 202-673-9319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: