Provider Demographics
NPI:1184114027
Name:CLEVELAND, GEOFFREY ALAN (PRS)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:ALAN
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 SYCAMORE LINE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4132
Mailing Address - Country:US
Mailing Address - Phone:419-626-9156
Mailing Address - Fax:
Practice Address - Street 1:1634 SYCAMORE LINE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4132
Practice Address - Country:US
Practice Address - Phone:419-626-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00290175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist