Provider Demographics
NPI:1700627841
Name:MANN, DASIA
Entity type:Individual
Prefix:MS
First Name:DASIA
Middle Name:
Last Name:MANN
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 1:2612 GREYFRIAR CT APT 2
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1446
Mailing Address - Country:US
Mailing Address - Phone:317-221-9485
Mailing Address - Fax:
Practice Address - Street 1:2612 GREYFRIAR CT APT 2A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1446
Practice Address - Country:US
Practice Address - Phone:317-221-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN991278097Medicaid