Provider Demographics
NPI:1598540437
Name:BEAUCHAMP, AMAYA
Entity Type:Individual
Prefix:
First Name:AMAYA
Middle Name:
Last Name:BEAUCHAMP
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 1:1356 ELEANOR AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2202
Mailing Address - Country:US
Mailing Address - Phone:419-205-3896
Mailing Address - Fax:
Practice Address - Street 1:2400 N REYNOLDS RD STE A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2833
Practice Address - Country:US
Practice Address - Phone:567-249-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator