Provider Demographics
NPI:1164125878
Name:MULUNDA, DENIS TSHIABA
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:TSHIABA
Last Name:MULUNDA
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 1:260 NORTHLAND BLVD STE 336
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4921
Mailing Address - Country:US
Mailing Address - Phone:513-771-0843
Mailing Address - Fax:513-771-0492
Practice Address - Street 1:4800 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-1716
Practice Address - Country:US
Practice Address - Phone:513-485-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide