MEDICARE: DAYANA ROBERSON B.A.

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	106S00000X	Behavior Technician
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1265201669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAYANA ROBERSON B.A.

Provider Business Mailing Address
First Line	:	2359 KNOLLWOOD AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-1525
Country	:	US
Telephone Number	:	216-260-1405
Fax Number	:	330-632-8823

Provider Business Practice Location Address
First Line	:	8000 BRIDLE LN NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1403
Country	:	US
Telephone Number	:	216-260-1405
Fax Number	:	330-632-8823

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

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	02/20/2024

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Directions to “ DAYANA ROBERSON B.A.” Practice Location

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