Provider Demographics
NPI:1699516880
Name:MCCALIP, TRAYVON
Entity type:Individual
Prefix:
First Name:TRAYVON
Middle Name:
Last Name:MCCALIP
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 1:4044 GRANT ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3544
Mailing Address - Country:US
Mailing Address - Phone:667-415-1480
Mailing Address - Fax:
Practice Address - Street 1:1151 4TH ST SW APT 615
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2356
Practice Address - Country:US
Practice Address - Phone:667-415-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant