MEDICARE: DAMONEE JAVON FISCHER

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	133N00000X	Nutritionist	UV054236	OH
2	172A00000X	Driver	UV054236	OH
3	251X00000X	Supports Brokerage Agency	UV054236	OH
4	376J00000X	Homemaker	UV054236	OH
5	3747P1801X	Personal Care Attendant	UV054236	OH

General Provider Information

NPI Number	:	1205637428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMONEE JAVON FISCHER

Provider Business Mailing Address
First Line	:	821 GREENWOOD AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-1860
Country	:	US
Telephone Number	:	330-808-7876
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 GREENWOOD AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-1860
Country	:	US
Telephone Number	:	330-808-7876
Fax Number	:

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

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	03/24/2025

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Directions to “ DAMONEE JAVON FISCHER ” Practice Location

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