Provider Demographics
NPI:1790542025
Name:GREER, SHAVONTAE
Entity Type:Individual
Prefix:
First Name:SHAVONTAE
Middle Name:
Last Name:GREER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAVONTAE
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:662 MULL AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7554
Mailing Address - Country:US
Mailing Address - Phone:330-703-6679
Mailing Address - Fax:
Practice Address - Street 1:662 MULL AVE APT 1D
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7554
Practice Address - Country:US
Practice Address - Phone:330-703-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)