MEDICARE: VITAVI PSYCHIATRY LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1538015813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAVI PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	7305 FATHER FRASCATI DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2077
Country	:	US
Telephone Number	:	216-677-0688
Fax Number	:

Provider Business Practice Location Address
First Line	:	7305 FATHER FRASCATI DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2077
Country	:	US
Telephone Number	:	216-677-0688
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	ALEXA DANNEMILLER
Credential	:	PMHNP-BC
Telephone Number	:	901-279-7148

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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