Provider Demographics
NPI:1164217246
Name:MCINTOSH, QUINDEL DESHAWN JR
Entity type:Individual
Prefix:
First Name:QUINDEL
Middle Name:DESHAWN
Last Name:MCINTOSH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 AVONDALE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2927
Mailing Address - Country:US
Mailing Address - Phone:234-244-9059
Mailing Address - Fax:234-244-9059
Practice Address - Street 1:1244 AVONDALE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-2927
Practice Address - Country:US
Practice Address - Phone:234-244-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X, 332U00000X, 347C00000X, 385H00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care