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NPI Code Detail

MEDICARE: SHELBY CLEVELAND

MEDICARE: SHELBY CLEVELAND
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
1374U00000XHome Health Aide

General Provider Information

NPI Number : 1619691789
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBY CLEVELAND
Provider Business Mailing Address
First Line : 368 KING AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43201-2616
Country : US
Telephone Number : 715-441-4530
Fax Number :
Provider Business Practice Location Address
First Line : 696 E SCHREYER PL
Second Line :
City : COLUMBUS
State : OH
Zip : 43214-2229
Country : US
Telephone Number : 614-579-9978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 10/03/2022

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Directions to “ SHELBY CLEVELAND ” Practice Location

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