Provider Demographics
NPI:1861193526
Name:DELJAUN LESHAWN FIELDS
Entity type:Organization
Organization Name:DELJAUN LESHAWN FIELDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREMIER
Authorized Official - Prefix:
Authorized Official - First Name:DELJAUN-LESHAWN:
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-309-9257
Mailing Address - Street 1:11811 SHAKER BLVD, STE
Mailing Address - Street 2:204 PMB 10027
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4185 EASTWAY RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-407-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty