Healthcare Provider Details

I. General information

NPI: 1336051010
Provider Name (Legal Business Name): MIKKIAH AMILLEON BASSIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MONTANA AVE NE
WASHINGTON DC
20018-3409
US

IV. Provider business mailing address

1200 N CAPITOL ST NW APT A614
WASHINGTON DC
20002-7526
US

V. Phone/Fax

Practice location:
  • Phone: 202-705-9580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: