Healthcare Provider Details

I. General information

NPI: 1962678920
Provider Name (Legal Business Name): JESSICA LYNN VENSEL RUNDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE S100C
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE S100C
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number35.093556
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number57.009428
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: