Provider Demographics
NPI:1871043596
Name:MAKHIAWALA, KENYA (PHD)
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:MAKHIAWALA
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2603
Mailing Address - Country:US
Mailing Address - Phone:419-251-7960
Mailing Address - Fax:419-251-3816
Practice Address - Street 1:2213 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1402
Practice Address - Country:US
Practice Address - Phone:419-251-2415
Practice Address - Fax:419-251-2415
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60603757103TC2200X
OHP.08747103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102635Medicaid