Healthcare Provider Details

I. General information

NPI: 1427982008
Provider Name (Legal Business Name): JESLYN ANNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 NEW DAWN LN
ODENTON MD
21113-2233
US

IV. Provider business mailing address

9244 HOMESTRETCH CT
LAUREL MD
20723-1875
US

V. Phone/Fax

Practice location:
  • Phone: 410-216-4535
  • Fax:
Mailing address:
  • Phone: 240-410-8061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: