Provider Demographics
NPI:1790539716
Name:AMOS, DARTAYSHA R
Entity Type:Individual
Prefix:
First Name:DARTAYSHA
Middle Name:R
Last Name:AMOS
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 1:1213 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3509
Mailing Address - Country:US
Mailing Address - Phone:330-612-7706
Mailing Address - Fax:
Practice Address - Street 1:1213 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3509
Practice Address - Country:US
Practice Address - Phone:330-612-7706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide