Provider Demographics
NPI:1750093449
Name:MCDUFFIE, EVAN LASHON
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:LASHON
Last Name:MCDUFFIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16402 ARCADE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1610
Mailing Address - Country:US
Mailing Address - Phone:216-860-8887
Mailing Address - Fax:
Practice Address - Street 1:16402 ARCADE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1610
Practice Address - Country:US
Practice Address - Phone:216-860-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services