Provider Demographics
NPI:1851852552
Name:AYERS, DAYLISHA LESLIE NICHOLE
Entity Type:Individual
Prefix:
First Name:DAYLISHA
Middle Name:LESLIE NICHOLE
Last Name:AYERS
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 1:861 WESTBURY LN S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-3280
Mailing Address - Country:US
Mailing Address - Phone:614-897-5913
Mailing Address - Fax:
Practice Address - Street 1:861 WESTBURY LN S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3280
Practice Address - Country:US
Practice Address - Phone:614-897-5913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000945175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty