Healthcare Provider Details

I. General information

NPI: 1598560401
Provider Name (Legal Business Name): GABRIELLA REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 BIG HILL RD
DAYTON OH
45439-2219
US

IV. Provider business mailing address

1822 QUAIL HOLLOW RD
DAYTON OH
45459-1227
US

V. Phone/Fax

Practice location:
  • Phone: 937-672-2073
  • Fax:
Mailing address:
  • Phone: 571-451-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: