MEDICARE: MS. YENAIRA ROMAN M.ED, PC

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	101Y00000X	Counselor	1200110	OH

General Provider Information

NPI Number	:	1457853244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YENAIRA ROMAN M.ED, PC

Provider Business Mailing Address
First Line	:	1276 W 3RD ST STE 210
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1512
Country	:	US
Telephone Number	:	216-443-8250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1276 W 3RD ST STE 210
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-1512
Country	:	US
Telephone Number	:	216-443-8250
Fax Number	:

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

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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