Provider Demographics
NPI:1225470131
Name:GIVENS, SHATWAN DETRISE (MA)
Entity Type:Individual
Prefix:MS
First Name:SHATWAN
Middle Name:DETRISE
Last Name:GIVENS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19831 LOCHERIE AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1423
Mailing Address - Country:US
Mailing Address - Phone:216-647-1380
Mailing Address - Fax:
Practice Address - Street 1:19831 LOCHERIE AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1423
Practice Address - Country:US
Practice Address - Phone:216-647-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide