Healthcare Provider Details

I. General information

NPI: 1417869611
Provider Name (Legal Business Name): JAYLAH KRISTINA MADDOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 58TH ST NE APT 322
WASHINGTON DC
20019-6822
US

IV. Provider business mailing address

4020 MINNESOTA AVE NE APT 312
WASHINGTON DC
20019-3525
US

V. Phone/Fax

Practice location:
  • Phone: 202-609-2926
  • Fax:
Mailing address:
  • Phone: 202-860-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: