Provider Demographics
NPI:1174909444
Name:ALLEGRA, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:ALLEGRA
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 1:1060 KINGSMILL PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1143
Mailing Address - Country:US
Mailing Address - Phone:614-848-4357
Mailing Address - Fax:614-848-5192
Practice Address - Street 1:1060 KINGSMILL PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1143
Practice Address - Country:US
Practice Address - Phone:614-848-4357
Practice Address - Fax:614-848-5192
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2510750Medicaid