MEDICARE: IVORY SIMS

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	374J00000X	Doula

General Provider Information

NPI Number	:	1679302459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVORY SIMS

Provider Business Mailing Address
First Line	:	10907 GRANDVIEW AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3528
Country	:	US
Telephone Number	:	216-307-1472
Fax Number	:

Provider Business Practice Location Address
First Line	:	10907 GRANDVIEW AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3528
Country	:	US
Telephone Number	:	216-307-1472
Fax Number	:

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

Provider Enumeration Date	:	07/30/2024
Last Update Date	:	10/30/2024

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Directions to “ IVORY SIMS ” Practice Location

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