MEDICARE: JESSICA DELORIS CHANDLER PA PROGRAM MANGER

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		OH

General Provider Information

NPI Number	:	1285421255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DELORIS CHANDLER PA PROGRAM MANGER

Provider Business Mailing Address
First Line	:	1313 S EDWIN C MOSES BLVD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-4036
Country	:	US
Telephone Number	:	937-396-1052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 S EDWIN C MOSES BLVD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-4036
Country	:	US
Telephone Number	:	937-396-1052
Fax Number	:

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

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	04/23/2025

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Directions to “ JESSICA DELORIS CHANDLER PA PROGRAM MANGER” Practice Location

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