Provider Demographics
NPI:1003542440
Name:WASHINGTON, MAYA JENAI
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:JENAI
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CROMWELL ALY APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1974
Mailing Address - Country:US
Mailing Address - Phone:843-990-3274
Mailing Address - Fax:
Practice Address - Street 1:5 CROMWELL ALY APT A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1974
Practice Address - Country:US
Practice Address - Phone:843-990-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCBL024377-0402021251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health