Healthcare Provider Details

I. General information

NPI: 1336009604
Provider Name (Legal Business Name): DESHAWNA FULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 UNDERWOOD AVE
TOLEDO OH
43607-3172
US

IV. Provider business mailing address

810 UNDERWOOD AVE
TOLEDO OH
43607-3172
US

V. Phone/Fax

Practice location:
  • Phone: 419-870-9590
  • Fax:
Mailing address:
  • Phone: 419-870-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: