Provider Demographics
NPI:1518669068
Name:AMEDA, AZEB
Entity Type:Individual
Prefix:
First Name:AZEB
Middle Name:
Last Name:AMEDA
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 1:311 ELM ST STE 270
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-2781
Mailing Address - Country:US
Mailing Address - Phone:513-628-0742
Mailing Address - Fax:
Practice Address - Street 1:5438 CLEANDER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-4265
Practice Address - Country:US
Practice Address - Phone:513-628-0742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSU523723343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)