Healthcare Provider Details

I. General information

NPI: 1558198192
Provider Name (Legal Business Name): AMATULLA ADRIENNE FAYE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3581 DALEFORD RD
SHAKER HEIGHTS OH
44120-5498
US

IV. Provider business mailing address

3581 DALEFORD RD
SHAKER HEIGHTS OH
44120-5498
US

V. Phone/Fax

Practice location:
  • Phone: 216-903-0840
  • Fax:
Mailing address:
  • Phone: 216-903-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: