Healthcare Provider Details

I. General information

NPI: 1770410375
Provider Name (Legal Business Name): MRS. MONIQUE C WYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 S MARGINAL RD STE 210
CLEVELAND OH
44103-1073
US

IV. Provider business mailing address

14002 ROCHELLE DR
MAPLE HEIGHTS OH
44137-4412
US

V. Phone/Fax

Practice location:
  • Phone: 216-273-7233
  • Fax:
Mailing address:
  • Phone: 216-554-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: