Healthcare Provider Details

I. General information

NPI: 1235074113
Provider Name (Legal Business Name): BRIANNA LILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 WARRENSVILLE CENTER RD
MAPLE HEIGHTS OH
44137-1915
US

IV. Provider business mailing address

3718 LUDGATE RD
SHAKER HEIGHTS OH
44120-5012
US

V. Phone/Fax

Practice location:
  • Phone: 440-753-1777
  • Fax:
Mailing address:
  • Phone: 216-851-6951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: