Healthcare Provider Details

I. General information

NPI: 1366121477
Provider Name (Legal Business Name): SYLVIA D DUCKSWORTH-BEARDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19004 CHICKASAW AVE
CLEVELAND OH
44119-2730
US

IV. Provider business mailing address

19004 CHICKASAW AVE
CLEVELAND OH
44119-2730
US

V. Phone/Fax

Practice location:
  • Phone: 216-256-4815
  • Fax:
Mailing address:
  • Phone: 216-256-4815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number423567
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: