Provider Demographics
NPI:1730770645
Name:MCCRAY, DAVON DEANDRE
Entity type:Individual
Prefix:
First Name:DAVON
Middle Name:DEANDRE
Last Name:MCCRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 H ST SE APT 217
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4987
Mailing Address - Country:US
Mailing Address - Phone:202-412-3403
Mailing Address - Fax:
Practice Address - Street 1:4638 H ST SE APT 217
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4987
Practice Address - Country:US
Practice Address - Phone:202-279-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care