Healthcare Provider Details

I. General information

NPI: 1265251474
Provider Name (Legal Business Name): WENDY STILLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

IV. Provider business mailing address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

V. Phone/Fax

Practice location:
  • Phone: 216-521-6511
  • Fax: 216-521-6006
Mailing address:
  • Phone: 216-521-6511
  • Fax: 216-521-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.2403791-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: