Healthcare Provider Details

I. General information

NPI: 1457712069
Provider Name (Legal Business Name): SYN DLYT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 EUCLID AVE
CLEVELAND OH
44103-3734
US

IV. Provider business mailing address

4500 EUCLID AVE
CLEVELAND OH
44103-3736
US

V. Phone/Fax

Practice location:
  • Phone: 216-432-7200
  • Fax: 216-432-7253
Mailing address:
  • Phone: 216-432-7200
  • Fax: 216-432-7253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS 0028887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: