Provider Demographics
NPI:1891359964
Name:SAFFOLD, ALISHA D
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:D
Last Name:SAFFOLD
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 1:1374 CHESTERTON SQ S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2649
Mailing Address - Country:US
Mailing Address - Phone:614-316-4987
Mailing Address - Fax:
Practice Address - Street 1:1374 CHESTERTON SQ S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2649
Practice Address - Country:US
Practice Address - Phone:614-316-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340561Medicaid
OH034887Medicaid