Healthcare Provider Details

I. General information

NPI: 1952041691
Provider Name (Legal Business Name): TRAYQUAN D SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 MASS AVE SE APT 100
WASHINGTON DC
20019-1154
US

IV. Provider business mailing address

4737 JOHN ST
SUITLAND MD
20746-3775
US

V. Phone/Fax

Practice location:
  • Phone: 202-583-2255
  • Fax:
Mailing address:
  • Phone: 301-793-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: