Healthcare Provider Details

I. General information

NPI: 1770165292
Provider Name (Legal Business Name): MS. TEMEKA MICHELLE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2229 E 68TH ST
CLEVELAND OH
44103-4717
US

IV. Provider business mailing address

2229 E 68TH ST
CLEVELAND OH
44103-4717
US

V. Phone/Fax

Practice location:
  • Phone: 440-983-7165
  • Fax:
Mailing address:
  • Phone: 440-983-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: