Provider Demographics
NPI:1568217974
Name:BLACKSHEAR, DELBRA A
Entity Type:Individual
Prefix:
First Name:DELBRA
Middle Name:A
Last Name:BLACKSHEAR
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 1:4348 BERWICK AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1504
Mailing Address - Country:US
Mailing Address - Phone:419-297-4544
Mailing Address - Fax:
Practice Address - Street 1:733 AMELIA ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-4233
Practice Address - Country:US
Practice Address - Phone:567-232-0389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care