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NPI Code Detail

MEDICARE: ANTONIO WESLEY

MEDICARE:   ANTONIO  WESLEY
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
1101Y00000XCounselorCDCA.164600OH

General Provider Information

NPI Number : 1558877829
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONIO WESLEY
Provider Business Mailing Address
First Line : 5162 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44127-1571
Country : US
Telephone Number : 216-938-6829
Fax Number :
Provider Business Practice Location Address
First Line : 5162 BROADWAY AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44127-1571
Country : US
Telephone Number : 216-938-6829
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2017
Last Update Date : 12/21/2017

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Directions to “ ANTONIO WESLEY ” Practice Location

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