Provider Demographics
NPI:1356058960
Name:AZONDJREDE, KOFFI TOSSINOU
Entity type:Individual
Prefix:
First Name:KOFFI
Middle Name:TOSSINOU
Last Name:AZONDJREDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 MYSTIC CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-5708
Mailing Address - Country:US
Mailing Address - Phone:614-902-5350
Mailing Address - Fax:
Practice Address - Street 1:3153 MYSTIC CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-5708
Practice Address - Country:US
Practice Address - Phone:614-902-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide