Provider Demographics
NPI:1871343160
Name:BOYD, LISHA
Entity type:Individual
Prefix:
First Name:LISHA
Middle Name:
Last Name:BOYD
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 1:1999 BRYDEN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1665
Mailing Address - Country:US
Mailing Address - Phone:614-735-4133
Mailing Address - Fax:
Practice Address - Street 1:1999 BRYDEN RD STE 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1665
Practice Address - Country:US
Practice Address - Phone:614-735-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
OH4769242347C00000X, 174200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
No175T00000XOther Service ProvidersPeer Specialist
No347C00000XTransportation ServicesPrivate Vehicle