Provider Demographics
NPI:1922793843
Name:DAVIDSON, DALEVON SR
Entity Type:Individual
Prefix:
First Name:DALEVON
Middle Name:
Last Name:DAVIDSON
Suffix:SR
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 1:1316 MARKLE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1842
Mailing Address - Country:US
Mailing Address - Phone:330-690-8050
Mailing Address - Fax:
Practice Address - Street 1:1316 MARKLE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-1842
Practice Address - Country:US
Practice Address - Phone:330-690-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUB831388372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider