Healthcare Provider Details

I. General information

NPI: 1104604669
Provider Name (Legal Business Name): SHYVONNE MONIQUE FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 STATE RD APT 212
PARMA OH
44134-4554
US

IV. Provider business mailing address

6900 HARVARD AVE APT 104
CLEVELAND OH
44105-5041
US

V. Phone/Fax

Practice location:
  • Phone: 216-647-1949
  • Fax:
Mailing address:
  • Phone: 216-647-1949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number194565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: