Healthcare Provider Details

I. General information

NPI: 1003310012
Provider Name (Legal Business Name): RYKIEL HALEY LEVINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 RICHMOND RD
BEACHWOOD OH
44122-6046
US

IV. Provider business mailing address

1220 W 6TH ST APT 806
CLEVELAND OH
44113-1329
US

V. Phone/Fax

Practice location:
  • Phone: 240-686-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number73760
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number309046
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.015534
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: