MEDICARE: ANDREA JOSEPHINE GINELLA

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1598443137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA JOSEPHINE GINELLA

Provider Business Mailing Address
First Line	:	8519 HIGH MILL AVE NW
Second Line	:
City	:	CANAL FULTON
State	:	OH
Zip	:	44614-8841
Country	:	US
Telephone Number	:	330-324-3824
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 LANDERHAVEN DR
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4129
Country	:	US
Telephone Number	:	216-245-3661
Fax Number	:

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

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	07/05/2023

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Directions to “ ANDREA JOSEPHINE GINELLA ” Practice Location

Language	Start Address	Practice Location

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