Healthcare Provider Details

I. General information

NPI: 1568789451
Provider Name (Legal Business Name): MRS. SHAWNTAYE TAKISHA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E WATERLOO RD STE 14
AKRON OH
44319-1236
US

IV. Provider business mailing address

215 E WATERLOO RD STE 14
AKRON OH
44319-1236
US

V. Phone/Fax

Practice location:
  • Phone: 330-634-3089
  • Fax: 234-542-2948
Mailing address:
  • Phone: 330-634-3089
  • Fax: 234-542-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7711417
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: