Provider Demographics
NPI:1962248450
Name:POLITE, DAYSHA RACHELE
Entity type:Individual
Prefix:
First Name:DAYSHA
Middle Name:RACHELE
Last Name:POLITE
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 1:3417 BELLINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-7105
Mailing Address - Country:US
Mailing Address - Phone:229-669-4056
Mailing Address - Fax:
Practice Address - Street 1:1120 W BROAD AVE STE B2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-4385
Practice Address - Country:US
Practice Address - Phone:229-669-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician