Healthcare Provider Details

I. General information

NPI: 1003722646
Provider Name (Legal Business Name): MRS. FELICIA MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 BLUESTONE RD
SOUTH EUCLID OH
44121-3427
US

IV. Provider business mailing address

4251 BLUESTONE RD
CLEVELAND OH
44121-3427
US

V. Phone/Fax

Practice location:
  • Phone: 216-258-8855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: