Provider Demographics
NPI:1952013682
Name:EVANS, SHAVON RENEE
Entity Type:Individual
Prefix:MS
First Name:SHAVON
Middle Name:RENEE
Last Name:EVANS
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 1:25000 EUCLID AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2646
Mailing Address - Country:US
Mailing Address - Phone:216-213-1137
Mailing Address - Fax:
Practice Address - Street 1:25000 EUCLID AVE STE 305
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2646
Practice Address - Country:US
Practice Address - Phone:216-213-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4672943343900000X
101YA0400X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No175T00000XOther Service ProvidersPeer Specialist