Provider Demographics
NPI:1316466170
Name:MASSEY, QUIANA DOMINIQUE
Entity type:Individual
Prefix:
First Name:QUIANA
Middle Name:DOMINIQUE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:QUIANA
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3839 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1748
Mailing Address - Country:US
Mailing Address - Phone:216-372-5596
Mailing Address - Fax:
Practice Address - Street 1:3839 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-1748
Practice Address - Country:US
Practice Address - Phone:216-372-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide