Provider Demographics
NPI:1073113312
Name:GRAYS, DISHELL
Entity Type:Individual
Prefix:
First Name:DISHELL
Middle Name:
Last Name:GRAYS
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 1:3180 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1828
Mailing Address - Country:US
Mailing Address - Phone:216-910-8977
Mailing Address - Fax:
Practice Address - Street 1:3180 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1828
Practice Address - Country:US
Practice Address - Phone:216-910-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide