Provider Demographics
NPI:1275290397
Name:GREGORY, DAJSHA
Entity Type:Individual
Prefix:
First Name:DAJSHA
Middle Name:
Last Name:GREGORY
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 1:11812 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1948
Mailing Address - Country:US
Mailing Address - Phone:216-304-0560
Mailing Address - Fax:
Practice Address - Street 1:11812 BUCKINGHAM AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1948
Practice Address - Country:US
Practice Address - Phone:216-304-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No332U00000XSuppliersHome Delivered Meals