MEDICARE: CHANELL DEAVER

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	374U00000X	Home Health Aide	UE444939	OH

General Provider Information

NPI Number	:	1659065464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANELL DEAVER

Provider Business Mailing Address
First Line	:	8119 LINWOOD AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3443
Country	:	US
Telephone Number	:	216-225-8749
Fax Number	:

Provider Business Practice Location Address
First Line	:	6516 SAINT CLAIR AVE APT 3
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-1636
Country	:	US
Telephone Number	:	216-225-8749
Fax Number	:

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

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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Directions to “ CHANELL DEAVER ” Practice Location

Language	Start Address	Practice Location

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