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General NPI Number Information
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NPI Number | 1275433906
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Entity Type | Individual
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Provider Name | EBONI SHAE HARRIS
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Gender | Female
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 6246 PHEASANT HILL RD
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City | DAYTON
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State | OH
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Zip | 45424-4185
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Country | US
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Telephone | 937-270-2854
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Fax |
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Provider Business Mailing Address
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Address Line | 6246 PHEASANT HILL RD
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City | DAYTON
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State | OH
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Zip | 45424-4185
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Country | US
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Telephone | 937-270-2854
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State | OH
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