MEDICARE: MISS DESHAY MARIE SCANDRICK CNP

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.10335	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851531628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DESHAY MARIE SCANDRICK CNP

Provider Business Mailing Address
First Line	:	3300 PHILADELPHIA DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1919
Country	:	US
Telephone Number	:	937-274-1501
Fax Number	:	937-274-1510

Provider Business Practice Location Address
First Line	:	3300 PHILADELPHIA DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1919
Country	:	US
Telephone Number	:	937-274-1501
Fax Number	:	937-274-1510

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

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	11/24/2020

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