Healthcare Provider Details

I. General information

NPI: 1033089867
Provider Name (Legal Business Name): DEVIN RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 GRANGER RD STE 8
CLEVELAND OH
44125-1979
US

IV. Provider business mailing address

3899 PRINCETON BLVD
CLEVELAND OH
44121-2334
US

V. Phone/Fax

Practice location:
  • Phone: 216-276-5533
  • Fax:
Mailing address:
  • Phone: 216-276-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: