Provider Demographics
NPI:1659986172
Name:LABRAKE, LYNDON
Entity Type:Individual
Prefix:MR
First Name:LYNDON
Middle Name:
Last Name:LABRAKE
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 1:6728 IVANDALE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5312
Mailing Address - Country:US
Mailing Address - Phone:216-264-4064
Mailing Address - Fax:
Practice Address - Street 1:6728 IVANDALE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-5312
Practice Address - Country:US
Practice Address - Phone:216-264-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider