MEDICARE: AKEISHA D WALLACE

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	343900000X	Non-emergency Medical Transport (VAN)	TF092794	OH
2	347C00000X	Private Vehicle	TF092794	OH
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1467046235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKEISHA D WALLACE

Provider Business Mailing Address
First Line	:	887 SELWYN RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-2343
Country	:	US
Telephone Number	:	440-691-8126
Fax Number	:

Provider Business Practice Location Address
First Line	:	887 SELWYN RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-2343
Country	:	US
Telephone Number	:	440-691-8126
Fax Number	:

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

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	04/14/2026

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Directions to “ AKEISHA D WALLACE ” Practice Location

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