Healthcare Provider Details

I. General information

NPI: 1649948613
Provider Name (Legal Business Name): MS. NADYA E REIDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS NADYA E REIDY

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 PROSPECT AVE E
CLEVELAND OH
44115-2614
US

IV. Provider business mailing address

1463 HOPKINS AVE
LAKEWOOD OH
44107-5020
US

V. Phone/Fax

Practice location:
  • Phone: 216-910-9015
  • Fax: 216-910-9015
Mailing address:
  • Phone: 440-213-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.180561
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: