MEDICARE: DAJEAN LEASIA ANGELO

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1891598546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAJEAN LEASIA ANGELO

Provider Business Mailing Address
First Line	:	507 FULLER ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2159
Country	:	US
Telephone Number	:	234-376-9799
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 FULLER ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2159
Country	:	US
Telephone Number	:	234-376-9799
Fax Number	:

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

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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Directions to “ DAJEAN LEASIA ANGELO ” Practice Location

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