Healthcare Provider Details

I. General information

NPI: 1942688312
Provider Name (Legal Business Name): CD HEALTHCARE ASSOCIATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 PORTAGE LINE RD
AKRON OH
44312-5704
US

IV. Provider business mailing address

1243 PORTAGE LINE RD
AKRON OH
44312-5704
US

V. Phone/Fax

Practice location:
  • Phone: 216-313-0154
  • Fax:
Mailing address:
  • Phone: 216-313-0154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.06660-NP
License Number StateOH

VIII. Authorized Official

Name: CYNTHIA DIDADO
Title or Position: OWNER
Credential: FNP
Phone: 216-313-0154