Individual
ELEONORA TATASHADZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PROVIDER
Contact information
Practice address
6613 FINEGAN DR, DAYTON, OH 45424-7112
(860) 726-6200
Mailing address
6613 FINEGAN DR, DAYTON, OH 45424-7112
(860) 726-6200
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
0000493
CT
171WH0202X
Home Modifications Contractor
Primary
4203630
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4203630
STATE OF OHIO CERTIFICATE
OH
Enumeration date
04/28/2011
Last updated
12/24/2020
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