Provider Demographics
NPI:1851909485
Name:SHREVES, CAMERON LAWRENCE
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:LAWRENCE
Last Name:SHREVES
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 1:698 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-2736
Mailing Address - Country:US
Mailing Address - Phone:440-251-8377
Mailing Address - Fax:440-744-4881
Practice Address - Street 1:698 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-2736
Practice Address - Country:US
Practice Address - Phone:440-251-8377
Practice Address - Fax:440-744-4881
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child