MEDICARE: SHEILA CLARK LCDCIII

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	171M00000X	Case Manager/Care Coordinator		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437876844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA CLARK LCDCIII

Provider Business Mailing Address
First Line	:	33275 AMBLESIDE DR
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-2381
Country	:	US
Telephone Number	:	440-263-7657
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 TURNEY RD
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2546
Country	:	US
Telephone Number	:	216-633-1334
Fax Number	:

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

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	01/13/2026

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Directions to “ SHEILA CLARK LCDCIII” Practice Location

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