MEDICARE: MS. LEAH GEORGEA PSELLAS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.006266RX	OH

General Provider Information

NPI Number	:	1336791615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEAH GEORGEA PSELLAS PA-C

Provider Business Mailing Address
First Line	:	10948 JASMINE CT
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44136-3767
Country	:	US
Telephone Number	:	440-572-1376
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-3767
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	06/12/2020

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