Provider Demographics
NPI:1609607969
Name:DUBOSE, QUOYA SHANTA
Entity type:Individual
Prefix:
First Name:QUOYA
Middle Name:SHANTA
Last Name:DUBOSE
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 1:14440 GRACE KELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-2010
Mailing Address - Country:US
Mailing Address - Phone:678-852-1897
Mailing Address - Fax:
Practice Address - Street 1:2619 DOUGLASS PL SE APT 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4468
Practice Address - Country:US
Practice Address - Phone:202-210-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant