MEDICARE: MONALISA P MCCOY

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	374U00000X	Home Health Aide	602340120323	OH

General Provider Information

NPI Number	:	1366137861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONALISA P MCCOY

Provider Business Mailing Address
First Line	:	5684 HAMLET AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1704
Country	:	US
Telephone Number	:	216-858-0271
Fax Number	:

Provider Business Practice Location Address
First Line	:	5684 HAMLET AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1704
Country	:	US
Telephone Number	:	216-858-0271
Fax Number	:

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

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/10/2023

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Directions to “ MONALISA P MCCOY ” Practice Location

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