Provider Demographics
NPI:1720959794
Name:ID-DEEN, DANIEL ELLOITT JR
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ELLOITT
Last Name:ID-DEEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 STONER ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3624
Mailing Address - Country:US
Mailing Address - Phone:330-957-9249
Mailing Address - Fax:
Practice Address - Street 1:941 STONER ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3624
Practice Address - Country:US
Practice Address - Phone:330-957-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker