Provider Demographics
NPI:1720690852
Name:CLEVELAND, SHERMAINE DEMETRIC
Entity Type:Individual
Prefix:
First Name:SHERMAINE
Middle Name:DEMETRIC
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1062
Mailing Address - Country:US
Mailing Address - Phone:678-634-5730
Mailing Address - Fax:
Practice Address - Street 1:1508 TEAKWOOD DR
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1062
Practice Address - Country:US
Practice Address - Phone:678-634-5730
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
Yes372600000XNursing Service Related ProvidersAdult Companion