Provider Demographics
NPI:1407745110
Name:MINGO, TAKESHA ERICA
Entity type:Individual
Prefix:
First Name:TAKESHA
Middle Name:ERICA
Last Name:MINGO
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 1:870 DOVER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2844
Mailing Address - Country:US
Mailing Address - Phone:330-310-0938
Mailing Address - Fax:
Practice Address - Street 1:870 DOVER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2844
Practice Address - Country:US
Practice Address - Phone:330-310-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver