Healthcare Provider Details

I. General information

NPI: 1851236285
Provider Name (Legal Business Name): ANNAJILL VANDYKE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HAYLEIGH ST
MILTON WV
25541-9114
US

IV. Provider business mailing address

3 HAYLEIGH ST
MILTON WV
25541-9114
US

V. Phone/Fax

Practice location:
  • Phone: 740-285-9585
  • Fax:
Mailing address:
  • Phone: 740-285-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: