Healthcare Provider Details

I. General information

NPI: 1548235138
Provider Name (Legal Business Name): MR. DONALD EDWARD CUDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 GARRETT RD
JEFFERSON OH
44047-8300
US

IV. Provider business mailing address

1518 GARRETT RD
JEFFERSON OH
44047-8300
US

V. Phone/Fax

Practice location:
  • Phone: 440-576-0980
  • Fax: 440-576-0085
Mailing address:
  • Phone: 440-576-0980
  • Fax: 440-576-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN258715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: