Provider Demographics
NPI:1225631302
Name:BYRD, GABRIELLE LATOSHA
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:LATOSHA
Last Name:BYRD
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 1:4303 TEXAS AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4259
Mailing Address - Country:US
Mailing Address - Phone:202-425-0396
Mailing Address - Fax:
Practice Address - Street 1:2629 DOUGLASS RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6589
Practice Address - Country:US
Practice Address - Phone:202-425-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant