MEDICARE: BRILLIANT MISFITS

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1629949516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRILLIANT MISFITS

Provider Business Mailing Address
First Line	:	25000 EUCLID AVE STE 106
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44117-2621
Country	:	US
Telephone Number	:	216-232-6092
Fax Number	:

Provider Business Practice Location Address
First Line	:	25000 EUCLID AVE STE 106
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44117-2621
Country	:	US
Telephone Number	:	216-232-6092
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER / DIRECTOR
Name	:	SASHA SALES
Credential	:
Telephone Number	:	216-502-0871

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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Directions to “BRILLIANT MISFITS ” Practice Location

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