Healthcare Provider Details

I. General information

NPI: 1558714857
Provider Name (Legal Business Name): TORNIA JOVANNA S WYLLIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # R3
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # R3
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5437
  • Fax: 216-636-6761
Mailing address:
  • Phone: 216-444-5437
  • Fax: 216-636-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.136256
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35.136256
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: