Provider Demographics
NPI:1790594109
Name:DEMONTE, ANIYA KENNEDI
Entity type:Individual
Prefix:
First Name:ANIYA
Middle Name:KENNEDI
Last Name:DEMONTE
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 1:21 1/2 HALL ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1534
Mailing Address - Country:US
Mailing Address - Phone:567-207-6696
Mailing Address - Fax:
Practice Address - Street 1:21 1/2 HALL ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1534
Practice Address - Country:US
Practice Address - Phone:567-207-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty