Healthcare Provider Details

I. General information

NPI: 1063140374
Provider Name (Legal Business Name): UNIVERSAL WELLNESS & AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2022
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 SMITH RD STE 15
FAIRLAWN OH
44333-3376
US

IV. Provider business mailing address

3029 SMITH RD STE 15
FAIRLAWN OH
44333-3376
US

V. Phone/Fax

Practice location:
  • Phone: 234-201-7811
  • Fax:
Mailing address:
  • Phone: 234-201-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHEVONNE SMITH
Title or Position: CEO
Credential: FNP-C
Phone: 330-957-5376