MEDICARE: LARONICA DEMEKA SCOTT

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	172A00000X	Driver		OH

General Provider Information

NPI Number	:	1194668640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARONICA DEMEKA SCOTT

Provider Business Mailing Address
First Line	:	6430 WESTFORD RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-1121
Country	:	US
Telephone Number	:	937-750-6821
Fax Number	:

Provider Business Practice Location Address
First Line	:	6430 WESTFORD RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-1121
Country	:	US
Telephone Number	:	937-750-6821
Fax Number	:

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

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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Directions to “ LARONICA DEMEKA SCOTT ” Practice Location

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