Provider Demographics
NPI:1992692719
Name:EZELL, DAJOHN SHANE RAQUAN
Entity type:Individual
Prefix:
First Name:DAJOHN
Middle Name:SHANE RAQUAN
Last Name:EZELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 NOBLE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2132
Mailing Address - Country:US
Mailing Address - Phone:330-327-0872
Mailing Address - Fax:
Practice Address - Street 1:2480 NOBLE RD APT 2
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2132
Practice Address - Country:US
Practice Address - Phone:330-327-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care