Healthcare Provider Details

I. General information

NPI: 1427604032
Provider Name (Legal Business Name): RAYSHAWN WELLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 08/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 RIDGE RD
PARMA OH
44129-3936
US

IV. Provider business mailing address

4500 EUCLID AVE
CLEVELAND OH
44103-3736
US

V. Phone/Fax

Practice location:
  • Phone: 440-888-0300
  • Fax:
Mailing address:
  • Phone: 216-325-9404
  • 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: