MEDICARE: ALYSSA VAUGHN

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	376J00000X	Homemaker
2	163W00000X	Registered Nurse	543081	OH

General Provider Information

NPI Number	:	1801732532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA VAUGHN

Provider Business Mailing Address
First Line	:	1816 PLEASANTDALE RD APT 10
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5793
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 PLEASANTDALE RD APT 10
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-5793
Country	:	US
Telephone Number	:	216-551-1775
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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Directions to “ ALYSSA VAUGHN ” Practice Location

Language	Start Address	Practice Location

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