Healthcare Provider Details

I. General information

NPI: 1245065507
Provider Name (Legal Business Name): YLONDA Y GRAFFAREE-TERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16309 CLEARVIEW AVE
CLEVELAND OH
44128-3709
US

IV. Provider business mailing address

16309 CLEARVIEW AVE
CLEVELAND OH
44128-3709
US

V. Phone/Fax

Practice location:
  • Phone: 216-762-6851
  • Fax:
Mailing address:
  • Phone: 216-762-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number$$$$$$$$$
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: