Provider Demographics
NPI:1891266243
Name:EVERAGE, EBONI SHAVON (CERTIFIED HAIRLOSS S)
Entity Type:Individual
Prefix:MS
First Name:EBONI
Middle Name:SHAVON
Last Name:EVERAGE
Suffix:
Gender:F
Credentials:CERTIFIED HAIRLOSS S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 NORTHCUT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6026
Mailing Address - Country:US
Mailing Address - Phone:513-628-3782
Mailing Address - Fax:
Practice Address - Street 1:1806 NORTHCUT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-6026
Practice Address - Country:US
Practice Address - Phone:513-628-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001141332B00000X, 171W00000X, 1744P3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171W00000XOther Service ProvidersContractor
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH001141OtherCRRTIFIED HAIR LOSS SPECIALIST