Provider Demographics
NPI:1770187387
Name:BANDA, ROSELYN KWADZANAI
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:KWADZANAI
Last Name:BANDA
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 1:5544 EUREKA DR STE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4210
Mailing Address - Country:US
Mailing Address - Phone:513-889-1220
Mailing Address - Fax:513-889-1233
Practice Address - Street 1:5544 EUREKA DR STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4210
Practice Address - Country:US
Practice Address - Phone:513-889-1220
Practice Address - Fax:513-889-1233
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0234270Medicaid
OH0906309OtherDEPARTMENT OF DEVELOPMENTAL DISABILITIES