Healthcare Provider Details

I. General information

NPI: 1104601053
Provider Name (Legal Business Name): JANIYA BURKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N REYNOLDS RD STE A
TOLEDO OH
43615-2833
US

IV. Provider business mailing address

1841 WOODS HOLE RD
PERRYSBURG OH
43551-2182
US

V. Phone/Fax

Practice location:
  • Phone: 567-249-5511
  • Fax:
Mailing address:
  • Phone: 419-705-8650
  • 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: