Provider Demographics
NPI:1639968027
Name:CUSHINBERRY, SHAVONNE
Entity type:Individual
Prefix:
First Name:SHAVONNE
Middle Name:
Last Name:CUSHINBERRY
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 1:712 S WEST ST APT 41
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:NE
Mailing Address - Zip Code:68064-9754
Mailing Address - Country:US
Mailing Address - Phone:402-813-3475
Mailing Address - Fax:
Practice Address - Street 1:317 S 17TH ST STE 726
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-1901
Practice Address - Country:US
Practice Address - Phone:402-421-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide