Provider Demographics
NPI:1043822125
Name:ELLIS, DAYONA (MED)
Entity type:Individual
Prefix:MRS
First Name:DAYONA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-1121
Mailing Address - Country:US
Mailing Address - Phone:717-220-3284
Mailing Address - Fax:
Practice Address - Street 1:336 LOCUST ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-1121
Practice Address - Country:US
Practice Address - Phone:717-220-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001291106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst