Healthcare Provider Details

I. General information

NPI: 1518803899
Provider Name (Legal Business Name): JETEENO CLOYD TRAINEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BANNER LN NW APT 106
WASHINGTON DC
20001-6086
US

IV. Provider business mailing address

22 BANNER LN NW APT 106
WASHINGTON DC
20001-6086
US

V. Phone/Fax

Practice location:
  • Phone: 855-329-8648
  • Fax: 888-972-3891
Mailing address:
  • Phone: 855-329-8648
  • Fax: 888-972-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number374U00000X
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: