MEDICARE: PROF. RALEIGHSHA SHELISSA SAMUELS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor	OH
2	172A00000X	Driver
3	172V00000X	Community Health Worker	OH
4	175T00000X	Peer Specialist	OH
5	251B00000X	Case Management Agency	OH
6	261QF0050X	Non-Surgical Family Planning Clinic/Center	OH
7	374J00000X	Doula
8	374U00000X	Home Health Aide
9	171M00000X	Case Manager/Care Coordinator	OH

General Provider Information

NPI Number	:	1114702578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. RALEIGHSHA SHELISSA SAMUELS

Provider Business Mailing Address
First Line	:	12323 CASTLEWOOD AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3919
Country	:	US
Telephone Number	:	216-307-0428
Fax Number	:

Provider Business Practice Location Address
First Line	:	12323 CASTLEWOOD AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3919
Country	:	US
Telephone Number	:	216-307-0428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	11/25/2024

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