Provider Demographics
NPI:1295469773
Name:BOYD, DE'ASIAH NATEERAH
Entity Type:Individual
Prefix:
First Name:DE'ASIAH
Middle Name:NATEERAH
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 MACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5300
Mailing Address - Country:US
Mailing Address - Phone:513-421-3494
Mailing Address - Fax:513-867-3241
Practice Address - Street 1:2960 MACK RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5300
Practice Address - Country:US
Practice Address - Phone:513-421-3494
Practice Address - Fax:513-867-3241
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC297363A00000X
OH50.007660RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant