Provider Demographics
NPI:1073990693
Name:SPEED, RODNESHA
Entity Type:Individual
Prefix:
First Name:RODNESHA
Middle Name:
Last Name:SPEED
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 1:4147 GREENVALE RD APT 103A
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2842
Mailing Address - Country:US
Mailing Address - Phone:440-319-7319
Mailing Address - Fax:
Practice Address - Street 1:4147 GREENVALE RD APT 103A
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2842
Practice Address - Country:US
Practice Address - Phone:440-319-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103295Medicaid