Healthcare Provider Details

I. General information

NPI: 1376314658
Provider Name (Legal Business Name): STANYA M GREATHOUSE MA, M ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27801 EUCLID AVE STE 600
EUCLID OH
44132-3548
US

IV. Provider business mailing address

10907 HULDA AVE
CLEVELAND OH
44104-3550
US

V. Phone/Fax

Practice location:
  • Phone: 216-562-9960
  • Fax:
Mailing address:
  • Phone: 614-902-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: