Healthcare Provider Details

I. General information

NPI: 1346450061
Provider Name (Legal Business Name): CAROLYN LEE HARDESTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN LEE HARDESTY MD

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 WASHINGTON ST
CHAGRIN FALLS OH
44022-4403
US

IV. Provider business mailing address

38655 PETTIBONE RD
SOLON OH
44139-5142
US

V. Phone/Fax

Practice location:
  • Phone: 440-893-9393
  • Fax:
Mailing address:
  • Phone: 715-650-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53714-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35094341
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: