Provider Demographics
NPI:1053846071
Name:RICHARD, FAITH ANYANGO (PA-C)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:ANYANGO
Last Name:RICHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4542 WARRENSVILLE CENTER RD APT 111C
Mailing Address - Street 2:
Mailing Address - City:NORTH RANDALL
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4198
Mailing Address - Country:US
Mailing Address - Phone:912-572-1789
Mailing Address - Fax:
Practice Address - Street 1:1569 VERNON ODOM BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4089
Practice Address - Country:US
Practice Address - Phone:330-867-7544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004947RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant