Basic Information
| Provider Information | |||||||||
| NPI: | 1265702450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAYDO | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8401 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445126725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307294298 | ||||||||
| FaxNumber: | 3307291897 | ||||||||
| Practice Location | |||||||||
| Address1: | 8401 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445126725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307294298 | ||||||||
| FaxNumber: | 3307291897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2012 | ||||||||
| LastUpdateDate: | 11/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.335975 | OH | N | Nursing Service Providers | Registered Nurse | 364SA2200X | APRN.CNS.12993 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 0080925 | 05 | OH | MEDICAID | 12509981 | 01 | CAQH | OTHER |