Provider Demographics
NPI:1851531628
Name:SCANDRICK, DESHAY MARIE (CNP)
Entity Type:Individual
Prefix:MISS
First Name:DESHAY
Middle Name:MARIE
Last Name:SCANDRICK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1919
Mailing Address - Country:US
Mailing Address - Phone:937-274-1501
Mailing Address - Fax:937-274-1510
Practice Address - Street 1:3300 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1919
Practice Address - Country:US
Practice Address - Phone:937-274-1501
Practice Address - Fax:937-274-1510
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.10335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2943944Medicaid
OHH059950Medicare PIN