Provider Demographics
NPI:1508288820
Name:ANIMASHAUN, AGNES (PA)
Entity Type:Individual
Prefix:MS
First Name:AGNES
Middle Name:
Last Name:ANIMASHAUN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:OTUEDON-ANIMASHAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:899 NORTH CAPITOL STREET NE ROOM 4000
Mailing Address - Street 2:DISTRICT OF COLUMBIA DEPT. OF HEALTH, STD/ TB DIV.
Mailing Address - City:DISTRICT OF COLUMBIA
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-671-4843
Mailing Address - Fax:
Practice Address - Street 1:1900 MASSACHUSETTS AVE, SE, BLD 6,8
Practice Address - Street 2:STD CLINIC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:202-698-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA30118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant