Provider Demographics
NPI:1346056256
Name:CLEVELAND, SHUNYA LEATRICE
Entity type:Individual
Prefix:
First Name:SHUNYA
Middle Name:LEATRICE
Last Name:CLEVELAND
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 1:500 TOBIN DR APT 2
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3592
Mailing Address - Country:US
Mailing Address - Phone:313-720-0446
Mailing Address - Fax:
Practice Address - Street 1:500 TOBIN DR APT 2
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-3592
Practice Address - Country:US
Practice Address - Phone:313-720-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker