Healthcare Provider Details

I. General information

NPI: 1831701325
Provider Name (Legal Business Name): AYSHA D MENDEZ QMHS 3YRS CMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 MOCK RD
COLUMBUS OH
43219-1258
US

IV. Provider business mailing address

3463 W 132ND ST
CLEVELAND OH
44111-2559
US

V. Phone/Fax

Practice location:
  • Phone: 614-914-8781
  • Fax:
Mailing address:
  • Phone: 216-785-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2405927-SUPV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: