Healthcare Provider Details

I. General information

NPI: 1194343749
Provider Name (Legal Business Name): RACHELLE FAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 01/08/2022
Certification Date: 01/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

26525 AMHEARST CIR APT 301
BEACHWOOD OH
44122-8508
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-8088
  • Fax:
Mailing address:
  • Phone: 330-774-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: