Healthcare Provider Details

I. General information

NPI: 1417807322
Provider Name (Legal Business Name): KEISHA ELLIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 RAYNOLDS PL SE
WASHINGTON DC
20020-3247
US

IV. Provider business mailing address

1657 U ST SE
WASHINGTON DC
20020-4830
US

V. Phone/Fax

Practice location:
  • Phone: 202-276-4204
  • Fax:
Mailing address:
  • Phone: 202-910-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: