Healthcare Provider Details

I. General information

NPI: 1023944360
Provider Name (Legal Business Name): DAVA SHIANN PETTRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 S MAIN ST STE 107
AKRON OH
44311-4402
US

IV. Provider business mailing address

2304 AGLER RD
COLUMBUS OH
43224-4606
US

V. Phone/Fax

Practice location:
  • Phone: 330-368-2400
  • Fax: 330-313-3849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: