Healthcare Provider Details

I. General information

NPI: 1760050835
Provider Name (Legal Business Name): DESHAWN LYNN FRASER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 RAYMOND ST
AKRON OH
44307-1959
US

IV. Provider business mailing address

965 RAYMOND ST
AKRON OH
44307-1959
US

V. Phone/Fax

Practice location:
  • Phone: 330-598-4303
  • Fax:
Mailing address:
  • Phone: 330-598-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: