Provider Demographics
NPI:1780140558
Name:DAMMONS, SHAVONNE TENA
Entity type:Individual
Prefix:
First Name:SHAVONNE
Middle Name:TENA
Last Name:DAMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAVONNE
Other - Middle Name:T
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1900 GLENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2212
Mailing Address - Country:US
Mailing Address - Phone:216-541-9494
Mailing Address - Fax:
Practice Address - Street 1:1900 GLENRIDGE RD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2212
Practice Address - Country:US
Practice Address - Phone:216-541-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347432163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse