MEDICARE: DEONTAY LYNCH

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	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1215736814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEONTAY LYNCH

Provider Business Mailing Address
First Line	:	3612 MENLO RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5053
Country	:	US
Telephone Number	:	216-762-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 MENLO RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5053
Country	:	US
Telephone Number	:	216-762-6611
Fax Number	:

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

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/07/2025

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Directions to “ DEONTAY LYNCH ” Practice Location

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