Individual
CHIMEREA DE'SHAY PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16212 KOLLIN AVE, CLEVELAND, OH 44128-3808
(216) 456-1530
Mailing address
16212 KOLLIN AVE, CLEVELAND, OH 44128-3808
(216) 456-1530
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
OH
374U00000X
Home Health Aide
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0228690
—
OH
05
—
0228848
—
OH
Enumeration date
04/12/2018
Last updated
04/12/2018
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