Provider Demographics
NPI:1942812235
Name:SCOTT, RAYSHUNDA PATRICE (HOME CARE AIDE)
Entity Type:Individual
Prefix:
First Name:RAYSHUNDA
Middle Name:PATRICE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:HOME CARE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23925 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2814
Mailing Address - Country:US
Mailing Address - Phone:216-269-9442
Mailing Address - Fax:
Practice Address - Street 1:23925 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2814
Practice Address - Country:US
Practice Address - Phone:216-269-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care