Provider Demographics
NPI:1205420510
Name:DEDEJCZYK, MONIKA DANUTA
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:DANUTA
Last Name:DEDEJCZYK
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 1:13275 SPRUCE RUN DR APT 310
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4282
Mailing Address - Country:US
Mailing Address - Phone:440-665-2829
Mailing Address - Fax:
Practice Address - Street 1:13275 SPRUCE RUN DR APT 310
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4282
Practice Address - Country:US
Practice Address - Phone:440-665-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH17500000Medicaid