Healthcare Provider Details

I. General information

NPI: 1639073315
Provider Name (Legal Business Name): PRAISE WELLINGTON DANIELS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5448 OLD COURT RD
RANDALLSTOWN MD
21133-5843
US

IV. Provider business mailing address

702 15TH ST NE
WASHINGTON DC
20002-4508
US

V. Phone/Fax

Practice location:
  • Phone: 240-688-8957
  • Fax:
Mailing address:
  • Phone: 202-388-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: