Provider Demographics
NPI:1679371439
Name:BODDIE, MICHENDA
Entity type:Individual
Prefix:
First Name:MICHENDA
Middle Name:
Last Name:BODDIE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 VANCOUVER DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4751
Mailing Address - Country:US
Mailing Address - Phone:937-267-0125
Mailing Address - Fax:
Practice Address - Street 1:1635 VANCOUVER DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4751
Practice Address - Country:US
Practice Address - Phone:937-267-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health