Healthcare Provider Details

I. General information

NPI: 1144150616
Provider Name (Legal Business Name): NYAH MARIE DENISE VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 NEIL AVE
COLUMBUS OH
43215-1609
US

IV. Provider business mailing address

1891 IDLEHURST DR
EUCLID OH
44117-1878
US

V. Phone/Fax

Practice location:
  • Phone: 614-228-8888
  • Fax:
Mailing address:
  • Phone: 216-825-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: