Provider Demographics
NPI:1710680178
Name:DANIELS, DE-SHAWNAY BETTIEANA-TANIESHA
Entity Type:Individual
Prefix:
First Name:DE-SHAWNAY
Middle Name:BETTIEANA-TANIESHA
Last Name:DANIELS
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 1:1613 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-1705
Mailing Address - Country:US
Mailing Address - Phone:330-371-8985
Mailing Address - Fax:
Practice Address - Street 1:1613 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1705
Practice Address - Country:US
Practice Address - Phone:330-371-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty