Provider Demographics
NPI:1033667795
Name:CEPHUS, MYISHA RAYNICE
Entity Type:Individual
Prefix:
First Name:MYISHA
Middle Name:RAYNICE
Last Name:CEPHUS
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 1:63 GALVESTON PL SW
Mailing Address - Street 2:1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2051
Mailing Address - Country:US
Mailing Address - Phone:202-491-2551
Mailing Address - Fax:
Practice Address - Street 1:63 GALVESTON PL SW
Practice Address - Street 2:1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2051
Practice Address - Country:US
Practice Address - Phone:202-491-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program