Healthcare Provider Details

I. General information

NPI: 1366372369
Provider Name (Legal Business Name): TIFFANY MACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GROSVENOR AVE
DAYTON OH
45417-2512
US

IV. Provider business mailing address

445 CUSHING AVE
KETTERING OH
45429-2609
US

V. Phone/Fax

Practice location:
  • Phone: 937-270-5525
  • Fax:
Mailing address:
  • Phone: 937-802-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: