Healthcare Provider Details

I. General information

NPI: 1952239923
Provider Name (Legal Business Name): MR. STEPHEN WAYNE PERRY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 KIRK LYNNE ST
DAYTON OH
45403-3217
US

IV. Provider business mailing address

715 KIRK LYNNE ST
DAYTON OH
45403-3217
US

V. Phone/Fax

Practice location:
  • Phone: 980-987-1401
  • Fax:
Mailing address:
  • Phone: 980-987-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: