Healthcare Provider Details

I. General information

NPI: 1508371238
Provider Name (Legal Business Name): JAMILA SHAFAWN HARDY CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 08/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WASHINGTON BLVD
CLEVELAND OH
44124
US

IV. Provider business mailing address

1238 BROADWAY AVE
BEDFORD OH
44146-4525
US

V. Phone/Fax

Practice location:
  • Phone: 216-727-2086
  • Fax:
Mailing address:
  • Phone: 216-450-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number165745
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: