Healthcare Provider Details

I. General information

NPI: 1609708171
Provider Name (Legal Business Name): AMY THEUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18697 BAGLEY RD
CLEVELAND OH
44130-3417
US

IV. Provider business mailing address

13909 BASSWOOD CIR
STRONGSVILLE OH
44136-2696
US

V. Phone/Fax

Practice location:
  • Phone: 440-816-8000
  • Fax:
Mailing address:
  • Phone: 216-701-3119
  • Fax: 216-701-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number418510
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: