Healthcare Provider Details

I. General information

NPI: 1801713441
Provider Name (Legal Business Name): EBONI SAYONKON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 NW 128TH ST STE 110
CLIVE IA
50325-7425
US

IV. Provider business mailing address

1449 NW 128TH ST STE 110
CLIVE IA
50325-7425
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-8136
  • Fax: 515-358-9159
Mailing address:
  • Phone: 515-358-9116
  • Fax: 515-358-9159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: