Provider Demographics
NPI:1447964481
Name:ZANDERS, DESHAUNA C
Entity type:Individual
Prefix:
First Name:DESHAUNA
Middle Name:C
Last Name:ZANDERS
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 1:1279 ROULHAC CIR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1129
Mailing Address - Country:US
Mailing Address - Phone:234-226-2165
Mailing Address - Fax:
Practice Address - Street 1:1735 S HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3902
Practice Address - Country:US
Practice Address - Phone:330-867-5400
Practice Address - Fax:330-869-8263
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.190707101YA0400X
OH7719432253Z00000X
OHRA.164334405300000X
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No253Z00000XAgenciesIn Home Supportive Care
No405300000XOther Service ProvidersPrevention Professional