MEDICARE: LAVENDER CHEYENNE DORSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1447102819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVENDER CHEYENNE DORSEY

Provider Business Mailing Address
First Line	:	13089 PRINCE GEORGES AVE NW
Second Line	:
City	:	UNIONTOWN
State	:	OH
Zip	:	44685-7320
Country	:	US
Telephone Number	:	762-822-4689
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 30TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-2902
Country	:	US
Telephone Number	:	330-438-3013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ LAVENDER CHEYENNE DORSEY ” Practice Location

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