Provider Demographics
NPI:1003616764
Name:ANDERSON, MARSHAY
Entity type:Individual
Prefix:
First Name:MARSHAY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19200 LAKE SHORE BLVD UPPR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1050
Mailing Address - Country:US
Mailing Address - Phone:216-303-1401
Mailing Address - Fax:
Practice Address - Street 1:19200 LAKE SHORE BLVD UPPR
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1050
Practice Address - Country:US
Practice Address - Phone:216-303-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH600585600125376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide