E G Sybrandy-Nicely, DPM

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

36-002389 Issued in OH

Legal business name

E G SYBRANDY-NICELY, DPM

Doing business as

Lisa Nicely, DPM

Practice address

1001 Shroyer Rd
Dayton, OH 45419-3635

Phone

(937) 293-8448

Fax

(937) 293-8448

NPI assigned

Feb 15, 2008

Last updated

Feb 15, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lisa G Nicely, DPM

Title

Owner/Podiatrist

Phone

(937) 293-8448

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Lisa Nicely, DPM Doing business as

Locations

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203033600000",
    "number": "1316115900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 SHROYER RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454193635",
            "telephone_number": "937-293-8448",
            "fax_number": "937-293-8448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SHROYER RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454193635",
            "telephone_number": "937-293-8448",
            "fax_number": "937-293-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E G SYBRANDY-NICELY, DPM",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-15",
        "last_updated": "2008-02-15",
        "status": "A",
        "authorized_official_last_name": "NICELY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/PODIATRIST",
        "authorized_official_telephone_number": "937-293-8448",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OH",
            "license": "36-002389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0969831",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI-INDIVIDUAL",
            "identifier": "1235138496",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lisa Nicely, DPM",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dynamic Physical Therapy Inc
• Christine Dyson, RN
• DZ Fastlane LLC
• Dariya Mukhamadovna Dzhavriyeva
• Samuel Kwami Dzodzomenyo, MD
• Veneice Eaddy
• Trinity Earl
• Leah Earle
• Brittany Ariel Earley
• Kristen D. Earley, RN

• Durable Medical Equipment & Medical Supplies in Dayton, OH
• Providers in Dayton, OH by specialty
• Durable Medical Equipment & Medical Supplies in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; 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.