Healthcare Provider Details

I. General information

NPI: 1942129390
Provider Name (Legal Business Name): TYSHAWN JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5566 PEARL RD
PARMA OH
44129-2541
US

IV. Provider business mailing address

5972 GLENWAY DR APT B
BROOKPARK OH
44142-1440
US

V. Phone/Fax

Practice location:
  • Phone: 440-488-5510
  • Fax:
Mailing address:
  • Phone: 440-488-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: