Provider Demographics
NPI:1457094443
Name:DREWERY, SHELMETA
Entity Type:Individual
Prefix:
First Name:SHELMETA
Middle Name:
Last Name:DREWERY
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:PO BOX 35514
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-0514
Mailing Address - Country:US
Mailing Address - Phone:216-413-7084
Mailing Address - Fax:
Practice Address - Street 1:13526 PURITAS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-2934
Practice Address - Country:US
Practice Address - Phone:216-413-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
376G00000X, 376K00000X, 385H00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care