Healthcare Provider Details

I. General information

NPI: 1487544094
Provider Name (Legal Business Name): CALIYAH MCLAURINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 RESERVOIR RD NW
WASHINGTON DC
20007-2111
US

IV. Provider business mailing address

5121 LANA RENEE CT
HERMITAGE TN
37076-3203
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-4221
  • Fax:
Mailing address:
  • Phone: 615-415-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: