Healthcare Provider Details

I. General information

NPI: 1851531628
Provider Name (Legal Business Name): DESHAY MARIE SCANDRICK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 FAR HILLS AVE
KETTERING OH
45429-2405
US

IV. Provider business mailing address

4441 FAR HILLS AVE
KETTERING OH
45429-2405
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-7351
  • Fax: 937-522-9806
Mailing address:
  • Phone: 937-298-7351
  • Fax: 937-522-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-CNP-10335
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.10335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: