Healthcare Provider Details

I. General information

NPI: 1558191932
Provider Name (Legal Business Name): ALISHA CANDICE GRAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251B SARATOGA AVE NE
WASHINGTON DC
20018-1025
US

IV. Provider business mailing address

4000 RUBY PLZ STE 3
CHRISTIANSTED VI
00820-5325
US

V. Phone/Fax

Practice location:
  • Phone: 202-469-4699
  • Fax:
Mailing address:
  • Phone: 340-772-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: