Provider Demographics
NPI:1386241305
Name:FORT, BRITANY SHAVON
Entity type:Individual
Prefix:
First Name:BRITANY
Middle Name:SHAVON
Last Name:FORT
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 1:12907 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5159
Mailing Address - Country:US
Mailing Address - Phone:216-926-7038
Mailing Address - Fax:
Practice Address - Street 1:12907 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-5159
Practice Address - Country:US
Practice Address - Phone:216-926-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401514770513376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide