MEDICARE: MIKEYAIRA DAMISHA PAYTON

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	3651878	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	:	1932734126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKEYAIRA DAMISHA PAYTON

Provider Business Mailing Address
First Line	:	21106 GARDENVIEW DR
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2428
Country	:	US
Telephone Number	:	216-256-0882
Fax Number	:

Provider Business Practice Location Address
First Line	:	21106 GARDENVIEW DR
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2428
Country	:	US
Telephone Number	:	216-256-0882
Fax Number	:

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

Provider Enumeration Date	:	03/08/2020
Last Update Date	:	03/08/2020

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