MEDICARE: DASIA WYATT

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1629916861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DASIA WYATT

Provider Business Mailing Address
First Line	:	352 W CEDAR ST APT C3
Second Line	:	C3
City	:	AKRON
State	:	OH
Zip	:	44307-2440
Country	:	US
Telephone Number	:	330-256-9041
Fax Number	:

Provider Business Practice Location Address
First Line	:	352 W CEDAR ST APT C3
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44307-2440
Country	:	US
Telephone Number	:	330-256-9041
Fax Number	:	330-256-9041

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

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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Directions to “ DASIA WYATT ” Practice Location

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