Provider Demographics
NPI:1891412508
Name:DAVIS, MALINDA DANIELLE (DODD)
Entity Type:Individual
Prefix:MISS
First Name:MALINDA
Middle Name:DANIELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DODD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 CLEVELAND HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1821
Mailing Address - Country:US
Mailing Address - Phone:216-288-8762
Mailing Address - Fax:
Practice Address - Street 1:1131 CLEVELAND HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-1821
Practice Address - Country:US
Practice Address - Phone:216-288-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 246ZE0500X, 376K00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractor
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty