Provider Demographics
NPI:1003403650
Name:NEWBY, DEVONTE LAMAR
Entity Type:Individual
Prefix:
First Name:DEVONTE
Middle Name:LAMAR
Last Name:NEWBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 MARSOL RD APT 103
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3518
Mailing Address - Country:US
Mailing Address - Phone:216-647-2661
Mailing Address - Fax:
Practice Address - Street 1:6509 MARSOL RD APT 103
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3518
Practice Address - Country:US
Practice Address - Phone:216-647-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTP833766376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker