Healthcare Provider Details

I. General information

NPI: 1730229840
Provider Name (Legal Business Name): CENTER FOR DYNAMIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 LILA AVE
MILFORD OH
45150
US

IV. Provider business mailing address

999 LILA AVE
MILFORD OH
45150
US

V. Phone/Fax

Practice location:
  • Phone: 513-831-0770
  • Fax:
Mailing address:
  • Phone: 513-831-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI 0001568
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35034102
License Number StatePW
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35034102
License Number StateOH

VIII. Authorized Official

Name: MRS. SHEILA DESILVA
Title or Position: OFFICE MANAGER
Credential:
Phone: 513-831-0700