Healthcare Provider Details

I. General information

NPI: 1730703059
Provider Name (Legal Business Name): JANESSA MARIE SAUCEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WILSON AVE
NILES OH
44446-1931
US

IV. Provider business mailing address

108 WILSON AVE
NILES OH
44446-1931
US

V. Phone/Fax

Practice location:
  • Phone: 330-978-4613
  • Fax:
Mailing address:
  • Phone: 330-978-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: