Healthcare Provider Details

I. General information

NPI: 1417869488
Provider Name (Legal Business Name): SHEMALE SPELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 HOMESTEAD RD
SOUTH EUCLID OH
44121-3537
US

IV. Provider business mailing address

1196 HOMESTEAD RD
SOUTH EUCLID OH
44121-3537
US

V. Phone/Fax

Practice location:
  • Phone: 216-482-9645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number602839880724
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: