Healthcare Provider Details

I. General information

NPI: 1568333664
Provider Name (Legal Business Name): ALFREDA D TRACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14902 EUCLID AVE
CLEVELAND HEIGHTS OH
44112-3408
US

IV. Provider business mailing address

1881 GRASMERE AVE
CLEVELAND OH
44112-3411
US

V. Phone/Fax

Practice location:
  • Phone: 440-339-3917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: