Healthcare Provider Details

I. General information

NPI: 1255165569
Provider Name (Legal Business Name): JAYLA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 GREEN CT
CLEVELAND OH
44104-1127
US

IV. Provider business mailing address

4207 GREEN CT
CLEVELAND OH
44104-1127
US

V. Phone/Fax

Practice location:
  • Phone: 216-235-1314
  • Fax:
Mailing address:
  • Phone: 440-941-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: