Provider Demographics
NPI:1659526226
Name:WASYLYSHEN, DEAN F (BOC(P))
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:F
Last Name:WASYLYSHEN
Suffix:
Gender:M
Credentials:BOC(P)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 W 800 S
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46938-9761
Mailing Address - Country:US
Mailing Address - Phone:317-831-0377
Mailing Address - Fax:
Practice Address - Street 1:3301 W FOX RIDGE LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6364
Practice Address - Country:US
Practice Address - Phone:765-288-3886
Practice Address - Fax:765-288-3444
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist