Healthcare Provider Details

I. General information

NPI: 1720671480
Provider Name (Legal Business Name): JEANNETTE BYROM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2021
Last Update Date: 12/14/2025
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SLATE DR
BEREA OH
44017-3131
US

IV. Provider business mailing address

124 SLATE DR
BEREA OH
44017-3131
US

V. Phone/Fax

Practice location:
  • Phone: 440-339-2368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: