MEDICARE: MRS. TANAYA DANIELLE CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093921033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TANAYA DANIELLE CLARK

Provider Business Mailing Address
First Line	:	1621 MIAMI CT NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44714-2343
Country	:	US
Telephone Number	:	330-454-5422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 MIAMI CT NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44714-2343
Country	:	US
Telephone Number	:	330-454-5422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/10/2009

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