Provider Demographics
NPI:1154748622
Name:MEHDEH, DYUTO ORETHA
Entity type:Individual
Prefix:MRS
First Name:DYUTO
Middle Name:ORETHA
Last Name:MEHDEH
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 1:153 DOVETAIL XING
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8995
Mailing Address - Country:US
Mailing Address - Phone:912-920-6220
Mailing Address - Fax:912-920-6288
Practice Address - Street 1:153 DOVETAIL XING
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-8995
Practice Address - Country:US
Practice Address - Phone:912-920-6220
Practice Address - Fax:912-920-6288
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-23
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4817903253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care