Healthcare Provider Details

I. General information

NPI: 1972323822
Provider Name (Legal Business Name): TEONDRA PARADISE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9804 YALE AVE
CLEVELAND OH
44108-2156
US

IV. Provider business mailing address

9804 YALE AVE
CLEVELAND OH
44108-2156
US

V. Phone/Fax

Practice location:
  • Phone: 216-645-2804
  • Fax:
Mailing address:
  • Phone: 216-645-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number000000
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: