Healthcare Provider Details

I. General information

NPI: 1881504603
Provider Name (Legal Business Name): DEONTE BRUNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 S ARLINGTON ST STE 2
AKRON OH
44306-1365
US

IV. Provider business mailing address

83 S ARLINGTON ST STE 2
AKRON OH
44306-1365
US

V. Phone/Fax

Practice location:
  • Phone: 234-817-9948
  • Fax:
Mailing address:
  • Phone: 234-817-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.008308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: