Provider Demographics
NPI:1689479297
Name:FAYNE, DEMIA NIKITA
Entity type:Individual
Prefix:
First Name:DEMIA
Middle Name:NIKITA
Last Name:FAYNE
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 1:29 AUGUSTA LN
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-5505
Mailing Address - Country:US
Mailing Address - Phone:216-570-9908
Mailing Address - Fax:
Practice Address - Street 1:29 AUGUSTA LN
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-5505
Practice Address - Country:US
Practice Address - Phone:216-570-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant