Healthcare Provider Details

I. General information

NPI: 1013798107
Provider Name (Legal Business Name): SEAN BOYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY RD
CLEVELAND OH
44130-3483
US

IV. Provider business mailing address

18660 BAGLEY RD
CLEVELAND OH
44130-3483
US

V. Phone/Fax

Practice location:
  • Phone: 440-223-2804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberAPRN.CNP.0033645
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN.CNP.0033645
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033645
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: