Provider Demographics
NPI:1093556201
Name:BYRD, DE'SHAUNA
Entity type:Individual
Prefix:
First Name:DE'SHAUNA
Middle Name:
Last Name:BYRD
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 1:4490 ASPEN LAKE DR STE 312
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4548
Mailing Address - Country:US
Mailing Address - Phone:216-832-8716
Mailing Address - Fax:
Practice Address - Street 1:4490 ASPEN LAKE DR STE 312
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4548
Practice Address - Country:US
Practice Address - Phone:216-832-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126800000X
172A00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No126800000XDental ProvidersDental Assistant
No172A00000XOther Service ProvidersDriver