Provider Demographics
NPI:1538976519
Name:NDAYISHIMIYE, JEROME
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:NDAYISHIMIYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NDAYISHIMIYE
Other - Middle Name:
Other - Last Name:JEROME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:782 POLK AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-3010
Mailing Address - Country:US
Mailing Address - Phone:330-803-6696
Mailing Address - Fax:
Practice Address - Street 1:782 POLK AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-3010
Practice Address - Country:US
Practice Address - Phone:330-803-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No171R00000XOther Service ProvidersInterpreter