Provider Demographics
NPI:1952197154
Name:ABDULLAH, TREVON DUANE SR
Entity type:Individual
Prefix:
First Name:TREVON
Middle Name:DUANE
Last Name:ABDULLAH
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4218
Mailing Address - Country:US
Mailing Address - Phone:440-990-6859
Mailing Address - Fax:
Practice Address - Street 1:3440 ASHBY RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-4218
Practice Address - Country:US
Practice Address - Phone:440-990-6859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTX172843374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide