Healthcare Provider Details

I. General information

NPI: 1083204986
Provider Name (Legal Business Name): JANAE GANAWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CAMDEN AVE
SALISBURY MD
21801-6837
US

IV. Provider business mailing address

1203 KENWOOD RD
GLEN BURNIE MD
21060-7014
US

V. Phone/Fax

Practice location:
  • Phone: 443-468-7134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: