Healthcare Provider Details

I. General information

NPI: 1689437543
Provider Name (Legal Business Name): SUZANNE DADDAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 CLINTON ST
COLUMBUS OH
43202-2739
US

IV. Provider business mailing address

448 CLINTON ST
COLUMBUS OH
43202-2739
US

V. Phone/Fax

Practice location:
  • Phone: 614-360-4798
  • Fax:
Mailing address:
  • Phone: 614-360-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: