Provider Demographics
NPI:1538940416
Name:HAMPTON, SHIRLEY DOMINIQUE
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:DOMINIQUE
Last Name:HAMPTON
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 1:12328 SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2924
Mailing Address - Country:US
Mailing Address - Phone:216-630-0143
Mailing Address - Fax:
Practice Address - Street 1:4008 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1546
Practice Address - Country:US
Practice Address - Phone:216-630-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant