Healthcare Provider Details

I. General information

NPI: 1346829942
Provider Name (Legal Business Name): GAYATHRI NAGENDIRAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 W 150TH ST
CLEVELAND OH
44111-5805
US

IV. Provider business mailing address

3838 W 150TH ST
CLEVELAND OH
44111-5805
US

V. Phone/Fax

Practice location:
  • Phone: 216-957-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number58.034843
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: