MEDICARE: JAMILA DAILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	0088674	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	108205214199	OTHER	OH	AETNA

General Provider Information

NPI Number	:	1063815660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMILA DAILEY

Provider Business Mailing Address
First Line	:	4530 LAKESIDE ST N APT I
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4387
Country	:	US
Telephone Number	:	614-572-9664
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 LAKESIDE ST N APT I
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4387
Country	:	US
Telephone Number	:	614-572-9664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2014
Last Update Date	:	09/27/2014

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Directions to “ JAMILA DAILEY ” Practice Location

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