Provider Demographics
NPI:1699411504
Name:ROYAL, KAWANNA SHANTA
Entity Type:Individual
Prefix:MISS
First Name:KAWANNA
Middle Name:SHANTA
Last Name:ROYAL
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 1:5150 E 88TH ST # A203
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2434
Mailing Address - Country:US
Mailing Address - Phone:216-471-7363
Mailing Address - Fax:
Practice Address - Street 1:5150 E 88TH ST # A203
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2434
Practice Address - Country:US
Practice Address - Phone:216-471-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker