Provider Demographics
NPI:1619209632
Name:CAMMON, DOVIYALE L
Entity Type:Individual
Prefix:MS
First Name:DOVIYALE
Middle Name:L
Last Name:CAMMON
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 1:4919 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4354
Mailing Address - Country:US
Mailing Address - Phone:440-475-9977
Mailing Address - Fax:216-475-9969
Practice Address - Street 1:4919 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-4354
Practice Address - Country:US
Practice Address - Phone:440-475-9977
Practice Address - Fax:216-475-9969
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017855C-D174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist