Healthcare Provider Details

I. General information

NPI: 1861309072
Provider Name (Legal Business Name): PEDS ISEEU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2736 BRYN MAWR DR
TOLEDO OH
43606-3940
US

IV. Provider business mailing address

2736 BRYN MAWR DR
TOLEDO OH
43606-3940
US

V. Phone/Fax

Practice location:
  • Phone: 419-705-2138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAQUALA LOGGINS
Title or Position: DIRECTOR
Credential: RN
Phone: 419-705-2138