Provider Demographics
NPI:1407616535
Name:MONTGOMERY, KESHAWN MASHAY
Entity Type:Individual
Prefix:
First Name:KESHAWN
Middle Name:MASHAY
Last Name:MONTGOMERY
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 1:3514 6TH STREET
Mailing Address - Street 2:APT 7
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3514 6TH ST SE APT 7
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3840
Practice Address - Country:US
Practice Address - Phone:202-975-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator