Healthcare Provider Details

I. General information

NPI: 1013729029
Provider Name (Legal Business Name): SHIREL SISTRUNK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4736 E 178TH ST
CLEVELAND OH
44128-3944
US

IV. Provider business mailing address

4736 E 178TH ST
CLEVELAND OH
44128-3944
US

V. Phone/Fax

Practice location:
  • Phone: 614-809-9577
  • Fax:
Mailing address:
  • Phone: 614-809-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: