Provider Demographics
NPI:1396347050
Name:MOSSHOOD, TANAYA R
Entity type:Individual
Prefix:MS
First Name:TANAYA
Middle Name:R
Last Name:MOSSHOOD
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 1:1254 DIETZ AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-2271
Mailing Address - Country:US
Mailing Address - Phone:330-612-8078
Mailing Address - Fax:330-786-9137
Practice Address - Street 1:1254 DIETZ AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-2271
Practice Address - Country:US
Practice Address - Phone:330-612-8078
Practice Address - Fax:330-786-9137
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100777Medicaid