MEDICARE: ZONTAYE RICHARDSON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171M00000X	Case Manager/Care Coordinator	OH
2	376J00000X	Homemaker	OH
3	347C00000X	Private Vehicle	OH

General Provider Information

NPI Number	:	1265021976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZONTAYE RICHARDSON

Provider Business Mailing Address
First Line	:	2634 MARCHMONT DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-1235
Country	:	US
Telephone Number	:	937-269-3214
Fax Number	:

Provider Business Practice Location Address
First Line	:	2634 MARCHMONT DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-1235
Country	:	US
Telephone Number	:	937-723-1986
Fax Number	:

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

Provider Enumeration Date	:	01/16/2021
Last Update Date	:	06/02/2026

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Directions to “ ZONTAYE RICHARDSON ” Practice Location

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