Healthcare Provider Details

I. General information

NPI: 1720818966
Provider Name (Legal Business Name): ANNY REYES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

26400 AMHEARST CIR APT 309
BEACHWOOD OH
44122-7585
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-0526
  • Fax:
Mailing address:
  • Phone: 646-648-7154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08668
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.08668
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: