Healthcare Provider Details

I. General information

NPI: 1427803329
Provider Name (Legal Business Name): MALIQUE REDDICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7608 FONTAINEBLEAU DR APT 179
NEW CARROLLTON MD
20784-3806
US

IV. Provider business mailing address

4800 N H BURROUGHS AVE NE APT 503
WASHINGTON DC
20019-3772
US

V. Phone/Fax

Practice location:
  • Phone: 240-521-5541
  • Fax:
Mailing address:
  • Phone: 202-553-5555
  • 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: