Provider Demographics
NPI:1669281762
Name:BOYD, ANTONIO DESHAWN (CNA)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:DESHAWN
Last Name:BOYD
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 E 154TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5164
Mailing Address - Country:US
Mailing Address - Phone:781-827-1298
Mailing Address - Fax:
Practice Address - Street 1:3550 E 154TH ST APT 2
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-5164
Practice Address - Country:US
Practice Address - Phone:781-827-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4004126510043747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty