=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093322034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. MELISSA KAY DRAGO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2020
-----------------------------------------------------
Last Update Date | 09/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10607 CHESTNUT HILL LN
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45458-6000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-243-5512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5798 ANNE LN
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-1654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-243-5512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | 0099397
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------