Healthcare Provider Details

I. General information

NPI: 1033791108
Provider Name (Legal Business Name): DESZIRAE MONIQUE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14602 LAKE SHORE BLVD APT 2
CLEVELAND OH
44110-1251
US

IV. Provider business mailing address

11459 MAYFIELD RD STE 117
CLEVELAND OH
44106-2363
US

V. Phone/Fax

Practice location:
  • Phone: 216-385-3407
  • Fax:
Mailing address:
  • Phone: 216-385-3407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: