Healthcare Provider Details

I. General information

NPI: 1780337600
Provider Name (Legal Business Name): CARLY DUREIKO MSFS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4495 W 226TH ST
FAIRVIEW PARK OH
44126-2569
US

IV. Provider business mailing address

4495 W 226TH ST
FAIRVIEW PARK OH
44126-2569
US

V. Phone/Fax

Practice location:
  • Phone: 216-952-7012
  • Fax:
Mailing address:
  • Phone: 216-952-7012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number08574
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: