Healthcare Provider Details

I. General information

NPI: 1063323657
Provider Name (Legal Business Name): MAKAYLA HUDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 EUCLID AVE
WILLOUGHBY OH
44094-4625
US

IV. Provider business mailing address

6159 PADERBORNE DR
HUDSON OH
44236-4901
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010530RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: