Healthcare Provider Details

I. General information

NPI: 1033475686
Provider Name (Legal Business Name): ASHANTI GEVALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 EUCLID ST NW APT #45
WASHINGTON DC
20009-5331
US

IV. Provider business mailing address

1101 EUCLID ST NW APT #45
WASHINGTON DC
20009-5331
US

V. Phone/Fax

Practice location:
  • Phone: 202-415-1023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2844065
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: