MEDICARE: LASHAWN MCCREARY

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	3747P1801X	Personal Care Attendant	1831241	OH
2	171W00000X	Contractor		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3764652	OTHER	OH	DODD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932717717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHAWN MCCREARY

Provider Business Mailing Address
First Line	:	1469 E 172ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-2926
Country	:	US
Telephone Number	:	216-804-7238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1469 E 172ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-2926
Country	:	US
Telephone Number	:	216-804-7238
Fax Number	:

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

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	07/17/2020

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Directions to “ LASHAWN MCCREARY ” Practice Location

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