Healthcare Provider Details

I. General information

NPI: 1346815313
Provider Name (Legal Business Name): TYLER JAMES SIMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 05/23/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 DRESSLER RD NW
CANTON OH
44718-2771
US

IV. Provider business mailing address

1222 SHADYSIDE AVE SW
CANTON OH
44710-2050
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-1300
  • Fax: 330-494-0828
Mailing address:
  • Phone: 330-488-7587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2005381
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: