Provider Demographics
NPI:1831789478
Name:BEAVER, DEVASTASHA (IBCLC)
Entity type:Individual
Prefix:
First Name:DEVASTASHA
Middle Name:
Last Name:BEAVER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-1410
Mailing Address - Country:US
Mailing Address - Phone:440-812-7630
Mailing Address - Fax:
Practice Address - Street 1:15 E ERIE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1410
Practice Address - Country:US
Practice Address - Phone:440-812-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN