Provider Demographics
NPI:1083973085
Name:SAUNDERS, KYSHA MONIQUE
Entity Type:Individual
Prefix:
First Name:KYSHA
Middle Name:MONIQUE
Last Name:SAUNDERS
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 1:1275 BRENTWOOD RD NE
Mailing Address - Street 2:#6
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1035
Mailing Address - Country:US
Mailing Address - Phone:202-258-8249
Mailing Address - Fax:
Practice Address - Street 1:1275 BRENTWOOD RD NE
Practice Address - Street 2:#6
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1035
Practice Address - Country:US
Practice Address - Phone:202-258-8249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2010379374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide