Healthcare Provider Details

I. General information

NPI: 1174480271
Provider Name (Legal Business Name): MRS. EVYENIA ALEXA SOPHOCLEOUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 S GREEN RD
SOUTH EUCLID OH
44121-3350
US

IV. Provider business mailing address

2111 S GREEN RD
SOUTH EUCLID OH
44121-3350
US

V. Phone/Fax

Practice location:
  • Phone: 330-398-9794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0041165
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: