MEDICARE: CHARDEJA KIDD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker		OH

General Provider Information

NPI Number	:	1114889441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARDEJA KIDD

Provider Business Mailing Address
First Line	:	2043 MARLINDALE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2512
Country	:	US
Telephone Number	:	216-889-7859
Fax Number	:

Provider Business Practice Location Address
First Line	:	2043 MARLINDALE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2512
Country	:	US
Telephone Number	:	216-889-7859
Fax Number	:

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

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	12/03/2025

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Directions to “ CHARDEJA KIDD ” Practice Location

Language	Start Address	Practice Location

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