Provider Demographics
NPI:1033899844
Name:SWANSON, RESHAYNE J I
Entity Type:Individual
Prefix:
First Name:RESHAYNE
Middle Name:J
Last Name:SWANSON
Suffix:I
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 1:18114 CORNWALL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1650
Mailing Address - Country:US
Mailing Address - Phone:216-990-1355
Mailing Address - Fax:216-313-9360
Practice Address - Street 1:18114 CORNWALL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-1650
Practice Address - Country:US
Practice Address - Phone:216-990-1355
Practice Address - Fax:216-313-9360
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP621947343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)