Healthcare Provider Details

I. General information

NPI: 1538976519
Provider Name (Legal Business Name): JEROME NDAYISHIMIYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NDAYISHIMIYE JEROME

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 POLK AVE
AKRON OH
44314-3010
US

IV. Provider business mailing address

782 POLK AVE
AKRON OH
44314-3010
US

V. Phone/Fax

Practice location:
  • Phone: 330-803-6696
  • Fax:
Mailing address:
  • Phone: 330-803-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: