Healthcare Provider Details

I. General information

NPI: 1437382660
Provider Name (Legal Business Name): ANDREA N WHITLEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 04/12/2025
Certification Date: 04/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST NW STE 300
WASHINGTON DC
20006-1631
US

IV. Provider business mailing address

1629 K ST NW
WASHINGTON DC
20006-1602
US

V. Phone/Fax

Practice location:
  • Phone: 240-704-1051
  • Fax:
Mailing address:
  • Phone: 240-704-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDN0000353
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN0000353
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: