Provider Demographics
NPI:1770270969
Name:SMITH, DIAMON RA'SEAN
Entity type:Individual
Prefix:
First Name:DIAMON
Middle Name:RA'SEAN
Last Name:SMITH
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 1:2029 E 40TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4364
Mailing Address - Country:US
Mailing Address - Phone:216-785-3430
Mailing Address - Fax:
Practice Address - Street 1:2029 E 40TH ST APT 204
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4364
Practice Address - Country:US
Practice Address - Phone:216-785-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide