Provider Demographics
NPI:1407539497
Name:MCCLENDON, CEDRIC J
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:J
Last Name:MCCLENDON
Suffix:
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 1:2105 ALPENA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2635
Mailing Address - Country:US
Mailing Address - Phone:937-604-6741
Mailing Address - Fax:
Practice Address - Street 1:2105 ALPENA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2635
Practice Address - Country:US
Practice Address - Phone:937-604-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion