Provider Demographics
NPI:1053994053
Name:MATAMBANADZO, SHANDI
Entity type:Individual
Prefix:MISS
First Name:SHANDI
Middle Name:
Last Name:MATAMBANADZO
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 1:17325 EUCLID AVENUE
Mailing Address - Street 2:SUITE 4171
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1278
Mailing Address - Country:US
Mailing Address - Phone:877-267-4824
Mailing Address - Fax:
Practice Address - Street 1:17325 EUCLID AVE STE 4171
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1278
Practice Address - Country:US
Practice Address - Phone:877-267-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2024-01-09
Deactivation Date:2023-09-11
Deactivation Code:
Reactivation Date:2024-01-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty