Provider Demographics
NPI:1184142614
Name:BERRYS, JOSEPHA LESLY
Entity type:Individual
Prefix:
First Name:JOSEPHA
Middle Name:LESLY
Last Name:BERRYS
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 1:3318 DODGE PARK RD APT 204
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2114
Mailing Address - Country:US
Mailing Address - Phone:240-440-9582
Mailing Address - Fax:
Practice Address - Street 1:501 SCHOOL ST SW STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2774
Practice Address - Country:US
Practice Address - Phone:703-310-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12951374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD42804282000Medicaid