Healthcare Provider Details

I. General information

NPI: 1992621395
Provider Name (Legal Business Name): DEANGELO WHITLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 N CAROLINA AVE SE
WASHINGTON DC
20003-3915
US

IV. Provider business mailing address

4410 G ST SE APT 12
WASHINGTON DC
20019-5052
US

V. Phone/Fax

Practice location:
  • Phone: 202-584-1873
  • Fax:
Mailing address:
  • Phone: 240-605-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: