Provider Demographics
NPI:1669781266
Name:KANVALLY, CLAUDETTE SHERAY (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:SHERAY
Last Name:KANVALLY
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 EASTPOINTE RIDGE DR APT 116
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1592
Mailing Address - Country:US
Mailing Address - Phone:405-833-0077
Mailing Address - Fax:
Practice Address - Street 1:53 EASTPOINTE RIDGE DR APT 116
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1592
Practice Address - Country:US
Practice Address - Phone:740-583-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide