Healthcare Provider Details

I. General information

NPI: 1093421091
Provider Name (Legal Business Name): THERESA E BOYD MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD STE 338-B
CLEVELAND OH
44104-3869
US

IV. Provider business mailing address

11201 SHAKER BLVD STE 338-B
CLEVELAND OH
44104-3869
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-7910
  • Fax:
Mailing address:
  • Phone: 216-368-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA BOYD
Title or Position: OWNER
Credential: MD
Phone: 330-958-4911