Provider Demographics
NPI:1346128162
Name:ANDERSON, DYMOND SAMANTHA
Entity type:Individual
Prefix:
First Name:DYMOND
Middle Name:SAMANTHA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 E MCMILLAN ST UNIT 1208
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-3058
Mailing Address - Country:US
Mailing Address - Phone:516-451-3830
Mailing Address - Fax:
Practice Address - Street 1:739 E MCMILLAN ST UNIT 1208
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-3058
Practice Address - Country:US
Practice Address - Phone:516-451-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator