Provider Demographics
NPI:1689439796
Name:DENNIS, JAMEL ARDAZAN
Entity Type:Individual
Prefix:
First Name:JAMEL
Middle Name:ARDAZAN
Last Name:DENNIS
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 1:5924 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-7724
Mailing Address - Country:US
Mailing Address - Phone:440-813-0095
Mailing Address - Fax:
Practice Address - Street 1:5924 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-7724
Practice Address - Country:US
Practice Address - Phone:440-813-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide