Provider Demographics
NPI:1780439687
Name:JAMES, DESTINY DEMORNAY
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:DEMORNAY
Last Name:JAMES
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 1:840 BROADWAY AVE APT 307
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3602
Mailing Address - Country:US
Mailing Address - Phone:216-325-8716
Mailing Address - Fax:
Practice Address - Street 1:840 BROADWAY AVE APT 307
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-3602
Practice Address - Country:US
Practice Address - Phone:216-325-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization