Healthcare Provider Details

I. General information

NPI: 1205637428
Provider Name (Legal Business Name): DAMONEE JAVON FISCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 GREENWOOD AVE
AKRON OH
44320-1860
US

IV. Provider business mailing address

821 GREENWOOD AVE
AKRON OH
44320-1860
US

V. Phone/Fax

Practice location:
  • Phone: 330-808-7876
  • Fax:
Mailing address:
  • Phone: 330-808-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberUV054236
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberUV054236
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License NumberUV054236
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberUV054236
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberUV054236
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: