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General NPI Number Information
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NPI Number | 1396336574
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Entity Type | Individual
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Provider Name | DECARLOS DEVANTE SANDERS
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Gender | Male
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Dates
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Enumeration Date | 01/29/2021
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 12700 SHAKER BLVD
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City | CLEVELAND
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State | OH
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Zip | 44120-2057
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Country | US
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Telephone | 216-678-9816
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Fax |
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Provider Business Mailing Address
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Address Line | 6216 STORER AVE
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City | CLEVELAND
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State | OH
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Zip | 44102-5526
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Country | US
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Telephone | 216-356-8371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | OH
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