Provider Demographics
NPI:1952973729
Name:DELAINE, KEISHA D
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:D
Last Name:DELAINE
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 1:7023 PAXTON RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4802
Mailing Address - Country:US
Mailing Address - Phone:330-272-8939
Mailing Address - Fax:
Practice Address - Street 1:7023 PAXTON RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4802
Practice Address - Country:US
Practice Address - Phone:330-272-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty