Provider Demographics
NPI:1003306283
Name:GRAHAM, MICHELLE DASHAM
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DASHAM
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17303 DEFOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2517
Mailing Address - Country:US
Mailing Address - Phone:216-256-8946
Mailing Address - Fax:
Practice Address - Street 1:17303 DEFOREST AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2517
Practice Address - Country:US
Practice Address - Phone:216-256-8946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide