Provider Demographics
NPI:1174018782
Name:ELLIOTT, DEVANTE ANTHONY
Entity Type:Individual
Prefix:
First Name:DEVANTE
Middle Name:ANTHONY
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 BROOKS DR APT 101
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5537
Mailing Address - Country:US
Mailing Address - Phone:202-702-5611
Mailing Address - Fax:
Practice Address - Street 1:1937 BROOKS DR APT 101
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5537
Practice Address - Country:US
Practice Address - Phone:202-702-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant