Healthcare Provider Details

I. General information

NPI: 1457216558
Provider Name (Legal Business Name): TALEAH BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7371 LAKE RD
CHIPPEWA LAKE OH
44215-9702
US

IV. Provider business mailing address

7371 LAKE RD
CHIPPEWA LAKE OH
44215-9702
US

V. Phone/Fax

Practice location:
  • Phone: 330-815-7308
  • Fax:
Mailing address:
  • Phone: 330-815-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: