Healthcare Provider Details

I. General information

NPI: 1518744457
Provider Name (Legal Business Name): ANANDA JOY HARRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GRAND AVE
DAYTON OH
45405-7538
US

IV. Provider business mailing address

104 NANTUCKET LNDG
CENTERVILLE OH
45458-4207
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-3276
  • Fax: 937-723-3277
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008407RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: