Provider Demographics
NPI:1538555446
Name:MASON, CANDAYSHA (CARE MANAGER)
Entity type:Individual
Prefix:
First Name:CANDAYSHA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:CARE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 CANDLEWICK CIR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8365
Mailing Address - Country:US
Mailing Address - Phone:513-693-3160
Mailing Address - Fax:
Practice Address - Street 1:4537 CANDLEWICK CIR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8365
Practice Address - Country:US
Practice Address - Phone:513-693-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH106410084399Medicare PIN