Healthcare Provider Details

I. General information

NPI: 1346187523
Provider Name (Legal Business Name): SHAWNITA SHARAY JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FAIRMONT ST NW APT 404
WASHINGTON DC
20009-6932
US

IV. Provider business mailing address

4826 BENNING RD SE APT 204
WASHINGTON DC
20019-6152
US

V. Phone/Fax

Practice location:
  • Phone: 202-425-4880
  • Fax:
Mailing address:
  • Phone: 202-867-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: