Provider Demographics
NPI:1215724422
Name:JEFFERSON, JUDY
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CHESAPEAKE ST SE APT 37
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2806
Mailing Address - Country:US
Mailing Address - Phone:301-212-0527
Mailing Address - Fax:
Practice Address - Street 1:407 COLUMBIA RD NW APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2901
Practice Address - Country:US
Practice Address - Phone:301-844-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant