Provider Demographics
NPI:1528665155
Name:VAUGHAN, CECILIA MARIE
Entity type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:MARIE
Last Name:VAUGHAN
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 1:2413 SKYLAND PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3412
Mailing Address - Country:US
Mailing Address - Phone:202-415-8787
Mailing Address - Fax:
Practice Address - Street 1:2413 SKYLAND PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3412
Practice Address - Country:US
Practice Address - Phone:202-415-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver