Healthcare Provider Details

I. General information

NPI: 1750266276
Provider Name (Legal Business Name): ANDREA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32927 PETTIBONE RD
SOLON OH
44139-5501
US

IV. Provider business mailing address

32927 PETTIBONE RD
SOLON OH
44139-5501
US

V. Phone/Fax

Practice location:
  • Phone: 216-716-9954
  • Fax: 216-716-9954
Mailing address:
  • Phone: 216-716-9954
  • Fax: 216-716-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: