Provider Demographics
NPI:1639061617
Name:JEFFERSON, MIYOSHA SIMONE
Entity type:Individual
Prefix:
First Name:MIYOSHA
Middle Name:SIMONE
Last Name:JEFFERSON
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 1:5009 40TH PL APT 108
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-2139
Mailing Address - Country:US
Mailing Address - Phone:202-300-2296
Mailing Address - Fax:
Practice Address - Street 1:304 V ST NE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1422
Practice Address - Country:US
Practice Address - Phone:240-432-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant