Edontre Malik Daugherty

Primary specialty

Home Health AideTaxonomy code 374U00000X

Practice address

5722 Ketcham Ave
Ashtabula, OH 44004-9779

Phone

(440) 813-9675

NPI assigned

Mar 5, 2021

Last updated

Mar 5, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1205421872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5722 KETCHAM AVE",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440049779",
            "telephone_number": "440-813-9675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5722 KETCHAM AVE",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440049779",
            "telephone_number": "440-813-9675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "EDONTRE",
        "middle_name": "MALIK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-05",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Dalrymple, PHARM D.
• Barbara Elaine Dalton, REGISTERED NURSE
• Anita Cristina Danes, OTRL
• Tessye Lynn Darden
• James Thomas Daubenspeck, CDCA
• Amanda Davis
• Susan Mary De Ridder
• Crystal Deak
• Michael Anthony Debellis, D.D.S.
• John E Decato, DPM

• Home Health Aide in Ashtabula, OH
• Providers in Ashtabula, OH by specialty
• Home Health Aide in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.