Healthcare Provider Details

I. General information

NPI: 1881271062
Provider Name (Legal Business Name): KELLIE GERVAS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 WARRENSVILLE CENTER RD
SHAKER HEIGHTS OH
44122-5203
US

IV. Provider business mailing address

8055 MAYFIELD RD STE 105
CHESTERLAND OH
44026-2447
US

V. Phone/Fax

Practice location:
  • Phone: 216-983-1028
  • Fax:
Mailing address:
  • Phone: 440-214-8026
  • Fax: 216-201-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34.018036
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: