Healthcare Provider Details

I. General information

NPI: 1619619855
Provider Name (Legal Business Name): ASHLEY CHRISTINA RE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19895 DETROIT RD
ROCKY RIVER OH
44116-1815
US

IV. Provider business mailing address

3618 SILSBY RD
CLEVELAND OH
44118-3665
US

V. Phone/Fax

Practice location:
  • Phone: 440-799-2255
  • Fax:
Mailing address:
  • Phone: 716-491-2209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.153505
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: