Healthcare Provider Details

I. General information

NPI: 1871190959
Provider Name (Legal Business Name): ANDREA AUTOMILUS BESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 03/22/2023
Certification Date: 03/08/2023
Deactivation Date: 10/20/2020
Reactivation Date: 03/07/2023

III. Provider practice location address

24390 LAKE SHORE BLVD APT C
EUCLID OH
44123-1277
US

IV. Provider business mailing address

24390 LAKE SHORE BLVD APT C
EUCLID OH
44123-1277
US

V. Phone/Fax

Practice location:
  • Phone: 216-952-6615
  • Fax:
Mailing address:
  • Phone: 216-952-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberRP931557
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberRP931557
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: