Individual
MRS. SHALANDA M ODOM-MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11305 KEPPLER CT, CLEVELAND, OH 44105-6242
(216) 801-2700
(216) 801-2700
Mailing address
11305 KEPPLER CT, CLEVELAND, OH 44105-6242
(216) 331-1321
(216) 331-1321
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
376939251197
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2365435
—
OH
Enumeration date
05/07/2007
Last updated
05/23/2014
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