Provider Demographics
NPI:1457248049
Name:BROADUS, LATOYA
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:BROADUS
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 1:6913 CLEMENT AVE # UP
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4940
Mailing Address - Country:US
Mailing Address - Phone:216-450-7689
Mailing Address - Fax:
Practice Address - Street 1:6913 CLEMENT AVE # UP
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4940
Practice Address - Country:US
Practice Address - Phone:216-450-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist