Healthcare Provider Details

I. General information

NPI: 1891612834
Provider Name (Legal Business Name): GERALD W FORMOSO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 COBBLESTONE RD
SHEFFIELD VILLAGE OH
44035-1489
US

IV. Provider business mailing address

4708 E PLEASANT VALLEY RD
INDEPENDENCE OH
44131-5221
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-7567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number02886
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: