Provider Demographics
NPI:1093522559
Name:BAILEY, DAYONNE LEDON (CPRS)
Entity type:Individual
Prefix:
First Name:DAYONNE
Middle Name:LEDON
Last Name:BAILEY
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3024
Mailing Address - Country:US
Mailing Address - Phone:937-750-5339
Mailing Address - Fax:
Practice Address - Street 1:237 W PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3024
Practice Address - Country:US
Practice Address - Phone:937-750-5539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005831175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty