Healthcare Provider Details

I. General information

NPI: 1053827873
Provider Name (Legal Business Name): SHARRON MARIE GORDON CDCA II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8411 BROADWAY AVE
CLEVELAND OH
44105-3932
US

IV. Provider business mailing address

8411 BROADWAY AVE
CLEVELAND OH
44105-3932
US

V. Phone/Fax

Practice location:
  • Phone: 216-441-0200
  • Fax:
Mailing address:
  • Phone: 216-441-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCDCA.161399
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: