Provider Demographics
NPI:1598435810
Name:SHAVERS, CHERYL JEAN
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:JEAN
Last Name:SHAVERS
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 1:1014 SEWARD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2628
Mailing Address - Country:US
Mailing Address - Phone:330-475-9515
Mailing Address - Fax:
Practice Address - Street 1:1014 SEWARD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2628
Practice Address - Country:US
Practice Address - Phone:330-475-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH575561Medicaid