Provider Demographics
NPI:1003379645
Name:OMOYAYI, DAISI A
Entity Type:Individual
Prefix:
First Name:DAISI
Middle Name:A
Last Name:OMOYAYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S 341ST PL STE C2
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6869
Mailing Address - Country:US
Mailing Address - Phone:206-397-7718
Mailing Address - Fax:
Practice Address - Street 1:1720 S 341ST PL STE C2
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6869
Practice Address - Country:US
Practice Address - Phone:206-397-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide