Provider Demographics
NPI:1528698891
Name:BUSSEY, DEONTE EUGENE
Entity type:Individual
Prefix:
First Name:DEONTE
Middle Name:EUGENE
Last Name:BUSSEY
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 1:7103 KIPLING PKWY
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2331
Mailing Address - Country:US
Mailing Address - Phone:024-366-0612
Mailing Address - Fax:
Practice Address - Street 1:1501 DOWNING ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3408
Practice Address - Country:US
Practice Address - Phone:301-736-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant