Provider Demographics
NPI:1114748746
Name:DOUGLAS, BREYA U-NIQUE
Entity type:Individual
Prefix:
First Name:BREYA
Middle Name:U-NIQUE
Last Name:DOUGLAS
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 1:705 BRANDYWINE ST SE APT 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3553
Mailing Address - Country:US
Mailing Address - Phone:202-699-0528
Mailing Address - Fax:
Practice Address - Street 1:1229 G ST SE APT 315
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-7012
Practice Address - Country:US
Practice Address - Phone:202-699-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC35291163747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant