Provider Demographics
NPI:1336722487
Name:SEPHUS, DAVON
Entity type:Individual
Prefix:
First Name:DAVON
Middle Name:
Last Name:SEPHUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 PERRYSBURG HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9582
Mailing Address - Country:US
Mailing Address - Phone:419-693-1520
Mailing Address - Fax:
Practice Address - Street 1:40 S WHEELING ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-2014
Practice Address - Country:US
Practice Address - Phone:419-691-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator