Healthcare Provider Details

I. General information

NPI: 1285506162
Provider Name (Legal Business Name): DONOVAN NIXON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 UNDERWOOD ST NW
WASHINGTON DC
20012-2637
US

IV. Provider business mailing address

5132 NEW HAMPSHIRE AVE NW # DC
WASHINGTON DC
20011-3210
US

V. Phone/Fax

Practice location:
  • Phone: 240-997-6944
  • Fax:
Mailing address:
  • Phone: 202-937-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLPCF2000225
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: