Provider Demographics
NPI:1588247258
Name:MOODY, TAMMY DENISE
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:DENISE
Last Name:MOODY
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 1:1430 L ST SE APT 403
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3254
Mailing Address - Country:US
Mailing Address - Phone:202-657-1226
Mailing Address - Fax:
Practice Address - Street 1:3005 BLADENSBURG RD NE APT 816
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2213
Practice Address - Country:US
Practice Address - Phone:202-269-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide