Provider Demographics
NPI:1760299614
Name:BADLEY, MYNASHA MONIQUE
Entity type:Individual
Prefix:
First Name:MYNASHA
Middle Name:MONIQUE
Last Name:BADLEY
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 1:324 OWEGO ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4135
Mailing Address - Country:US
Mailing Address - Phone:216-450-9713
Mailing Address - Fax:
Practice Address - Street 1:324 OWEGO ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4135
Practice Address - Country:US
Practice Address - Phone:216-450-9713
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
Yes376J00000XNursing Service Related ProvidersHomemaker