Provider Demographics
NPI:1932734126
Name:PAYTON, MIKEYAIRA DAMISHA
Entity Type:Individual
Prefix:
First Name:MIKEYAIRA
Middle Name:DAMISHA
Last Name:PAYTON
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 1:21106 GARDENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2428
Mailing Address - Country:US
Mailing Address - Phone:216-256-0882
Mailing Address - Fax:
Practice Address - Street 1:21106 GARDENVIEW DR
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2428
Practice Address - Country:US
Practice Address - Phone:216-256-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651878374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHUQ479386Medicaid